Saturday, November 14, 2009

Pearls on AIDS related neuropathies

see Gonzalez-Duarte A, Robinson-Papp J, Simpson DM. Diagnosis and management of HIV associated neuropathy. Neurol Clinics 2008; 26:821-832
1. Antiretroviral distal sensory neuropathy (ARV-DSP) occurs with didanosin (ddI), zalcitarabine (ddC), stavudine (d4T) plus more recently, adanavir, saquinavir, and ritonavir. It occurs chiefly in first year of treatment or in patients with preexisting neuropathy. Symptoms occur with drug onset and resolve with discontinuation of the drug.
2. DSP due to HIV was formerly associated with high viral load, and low CD4 count and occurs in nearly 100 % at autopsy, and 30-50 percent in clinical practice. Other risk factors are older age, low nadir CD4 count, poor nutrition, coexisting diabetes, and use of neurotoxic drugs (such as antiretrovirals) or alcohol.
3. Of newer drugs, duloxetine is FDA approved for DPNP (diabetic peripheral neuropathy pain) and is under study in HIV DSP. Lamotrigine has been shown to be effective. Elavil and NSIAAD's have not been shown to work.
4. Polyradiculitis is usually pure motor and can be due to CMV, TB, cryptoccosis, and meningeal lymphocytosis. Treponema also has been described. Presentation was usually progressive weakness starting weeks before onset. One case had cervical disease, the rest were lumbar.

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