HIV-related peripheral nervous system illness

As HIV has been transformed into a chronic disease by the use of combination antiretroviral therapy (CART), focus has shifted toward management of the chronic complications of HIV-infected individuals. These include a variety of disorders of the peripheral nervous system, which are addressed in this chapter. Among these disorders, distal symmetric polyneuropathy (DSP) is the most common and typically presents with uncomfortable sensory symptoms in the feet. Given the lack of neuroregenerative treatment for DSP, therapy focuses on control of painful symptoms with agents such as antiepileptics and antidepressants. DSP may predispose HIV-infected patients to other forms of neuropathy. These include autonomic neuropathy, the symptoms of which vary depending on the organ systems involved, and mononeuropathies such as carpal tunnel syndrome. In addition to these common peripheral nerve disorders, which are thought to be mechanistically linked to HIV, we also discuss other disorders that are common in the HIV-infected population perhaps due to accentuated aging, such as radiculopathy due to degenerative spine disease. Finally, we address rare neuromuscular conditions that have been reported in HIV-infected patients including the demyelinating neuropathies, mononeuropathy multiplex, the diffuse infiltrative lymphocytosis syndrome, amyotrophic lateral sclerosis, and myopathy.