HIV-Related Pain Syndromes
Egle Bavry, M.D.
Department of Anesthesiology
University of Florida and North Florida/South Georgia VA
Robert W. Hurley, M.D., Ph.D.
Department of Anesthesiology, Neurology, Psychiatry, Orthopedics and Rehabilitation, and Neurosurgery
University of Florida
Introduction
- TOP
With the development and widespread use of highly active antiretroviral therapy (HAART) and the resulting decrease in opportunistic infections of the central nervous system, polyneuropathy has become the most prevalent neurological complication associated with human immunodeficiency virus (HIV) infection.1 Although symptomatic neuropathy occurs in 10 to 35% of those seropositive for HIV, pathologic abnormalities exist in almost all of those with end-stage AIDS.1, 2 There are numerous types of the HIV-associated neuropathy classified by onset, putative etiology, pathology of nerve damage, and motor or sensory involvement (please see Keswani3 for review). The sensory neuropathies associated with HIV (HIV-SN) include distal sensory polyneuropathy (DSP) due to the viral infection and antiretroviral toxic neuropathy (ATN) due to the medical treatment of the viral illness. DSP represents the more common of the two disorders.
Although these HIV-SNs may represent two distinct entities,4 the clinical syndrome, and pathophysiologic manifestation of the two disorders are practically indistinguishable. The time course of the illness and temporal relation to the commencement of anti-retroviral therapy represents the primary differentiating characteristic. The onset of DSP can occur in either the subacute or chronic phases, or following the development of an AIDS-defining illness. The clinical manifestation of ATN can appear within the first week to six months of the initiation of antiretroviral therapy and may subside after its cessation.
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