Peripheral neuropathy

Neuropathy refers to any type of nerve damage or injury. Neuropathy is common in people with HIV and AIDS and may be related to HIV infection itself and/or the drugs used to treat HIV. It occurs in 30 to 60% of persons with HIV infection and significantly impairs quality of life. It is often under-treated.

The nervous system consists of the central nervous system (CNS), comprised of the brain and the spinal cord, and the peripheral nervous system (PNS), comprised of the nerves that connect the CNS to the skin, muscles, and organs throughout the body. Peripheral nerves are responsible for sensation (sensory nerves), movement (motor nerves), and automatic bodily functions (autonomic nerves). Damage to nerves in the PNS is referred to as peripheral neuropathy.

Some anti-HIV drugs, in particular the dideoxynucleoside reverse transcriptase inhibitors, or ‘d-drugs,’ can cause peripheral neuropathy. Such agents are referred to as neurotoxic. There are several different forms of peripheral neuropathy, classified according to the types of nerves affected:

• Sensory neuropathy affects the nerves that relay information from the sense organs and those responsible for sensation (pain, pressure, heat) in the skin.
• Motor neuropathy affects the nerves that relay instructions from the spinal cord to the muscles and other parts of the body that carry out voluntary action.
• Autonomic neuropathy affects the nerves that control automatic bodily functions such as breathing, heartbeat, sweating, and emptying of the stomach.

In persons with HIV and AIDS, most neuropathy is distal symmetrical polyneuropathy, meaning it starts in the extremities, affects both sides of the body, and involves multiple nerves. Neuropathy induced by anti-HIV medications is sometimes called antiretroviral toxic neuropathy.