Jan 8, 1997 - Keywords: Peripheral neuropathies, HIV infection, review, treatment, cytomegalovirus ... This is also a monophasic, progressive polyneuro-.
Intentntional lournal of STD A AIDS 7997;8:7612
CONTINUING MEDICAL EDUCATION
Peripheral neuropathy in HIV M Sadler
PhD MRCP
and M Nelson MA
MRCP
Directorate of HIV/GUM, Chelsea and Westruinster NHS Trust, London, UK
Keywords: Peripheral neuropathies, HIV infection, review, treatment, cytomegalovirus
INTRODUCTION A wide variety of peripheral nerve syndromes have been described in patients with HIV infection from seroconversion
to the late stages of AIDS.
The
incidence of peripheral nerve involvement increases with falling CD4 count, and subclinical evidence of peripheral neuropathy may be found in up to 90%
of AIDS patientsl.
The type of peripheral neuropathy affecting
a
patient depends on the stage of HIV infection and CD4 count. Syndromes which are immune mediated, such as inflammatory demyelinating
polyneuropathy (IDP) or mononeuritis multiplex (MM) occur early in HIV infection and may occur at seroconversion, whereas syndromes caused by viral infections, such as those related to the action of cytomegalovirus (CMV) occur late in AIDS. Table 1 shows the major categories of peripheral nerve syndromes, the approximate CD4 count at which they occur and an estimation of their frequency in HlV-infected patients. It is of note that the most common neuropathy is a distal symmetrical polyneuropathy (DSP) which accounts for over 90% of all HlV-related neuropathies2.
INFLAMMATORY DEMYELINATING POLYNEUROPATHY (IDP) Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
An AIDP, clinically very similar to Guillain-Barr6 syndrome (GBS), has been reported in early HIV infection either as a seroconversion i1hess3,4 or during the asymptomatic phase of infections. Although a rare disease in HIV, in a study in Zimbabwe, 59% of consecutive patients with AIDP were found to be HlV-positive on testing6. Certainly this association between AIDP and HIV is stronger than expected by chance alone5,7, and is strong enough to suggest HIV testing in all patients
presenting with GBS. As AIDP is an immune mediated disorder it occurs early in the course of HIV disease rather than in the later stages of immune depletion. There are temporal associations between the occurrence of AIDP in HIV and infection with mycoplasma, campylobacters, hepatitise and CMV5,7, either at the time of presentation
Table 1. Major peripheral nerzte syndromes, CD4 (/mm3) count nt ruhich they are likely and relatiae frequertcy of occurrcttce in HIV patients
Type of neuropathy
CD4
count/ mm3
Frequency of occurrence
>500 >500
< 1% (Ref 2) 500,