Human immunodeficiency virus–related peripheral neuropathy: A systematic review and meta‐analysis

Abstract

Background and purpose Human immunodeficiency virus (HIV)‐associated neurological syndromes occur in affected individuals as a consequence of primary HIV infection, opportunistic infections, inflammation and as an adverse effect of some forms of antiretroviral treatment (ART). The aim of this systematic review was to establish the epidemiological characteristics, clinical features, pathogenetic mechanisms and risk factors of HIV‐related peripheral neuropathy (PN). Methods A systematic, computer‐based search was conducted using the PubMed database. Data regarding the above parameters were extracted. Ninety‐four articles were included in this review. Results The most commonly described clinical presentation of HIV neuropathy is the distal predominantly sensory polyneuropathy. The primary pathology in HIVPN appears to be axonal rather than demyelinating. Age and treatment with medications belonging in the nucleoside analogue reverse transcriptase class are risk factors for developing HIV‐related neuropathy. The pooled prevalence of PN in patients naïve to ARTs was established to be 29% (95% CI: 9%–62%) and increased to 38% (95% confidence interval [CI]: 29%–48%) when looking into patients at various stages of their disease. More than half of patients with HIV‐related neuropathy are symptomatic (53%, 95% CI: 41%–63%). Management of HIV‐related neuropathy is mainly symptomatic, although there is evidence that discontinuation of some types of ART, such as didanosine, can improve or resolve symptoms. Conclusions Human immunodeficiency virus–related neuropathy is common and represents a significant burden in patients’ lives. Our understanding of the disease has grown over the last years, but there are unexplored areas requiring further study.

Automation of Quantifying Axonal Loss in Patients with Peripheral Neuropathies through Deep Learning Derived Muscle Fat Fraction

“…Peripheral neuropathies are a group of diseases presenting with numbness, tingling, pain in feet and hands, tripping, fall, and muscle weakness/atrophy in distal limbs 1 . These diseases are highly prevalent 2 and caused by a variety of conditions, such as diabetes, viral infection, vitamin deficiency, renal disease, alcohol abuse, medication side effect, and so on 3–5 . When the disease is caused by a monogenic mutation, it is collectively called Charcot–Marie–Tooth (CMT) disease 6 .…”

Sudomotor dysfunction in patients with gluten neuropathy

“…Being on a strict gluten-free diet improves the overall QoL and reduces dramatically the odds of suffering from peripheral neuropathic pain (PNP) [8]. PNP is present in about 60% of patients suffering from GN, a figure also seen in PN of other etiologies [9][10][11][12][13][14][15]. PNP is a result of small fiber involvement [16].…”

Distal Sensory Peripheral Neuropathy: An Undervalued Determinant of Wellbeing

“…Peripheral neuropathy (PN) is a significant, frequently debilitating complication of HIV infection and diabetes caused by damage to the sensory and motor peripheral nerves. In persons with HIV infection (PWH), neuropathy is thought to result from highly active antiretroviral therapy (HAART) neurotoxicity, particularly stavudine (d4T), dideoxycytidine (ddC), and didanosine (ddI), effects of HIV, or both [1]. Advanced age, taller height (as a proxy for longer neuronal axons), comorbid diabetes, and treatment with nucleotide reverse transcriptase inhibitors (NRTI), increased PN risk [2].…”

“…Advanced age, taller height (as a proxy for longer neuronal axons), comorbid diabetes, and treatment with nucleotide reverse transcriptase inhibitors (NRTI), increased PN risk [2]. Among patients with diabetes, neuropathy is likely the culmination of multiple chronic insults to the nervous system, including hyperglycemia, microvascular insufficiency, oxidative stress, and autoimmunity [1,3,4]. Risk increases with advancing age and duration of diabetes, poor glycemic control, high body mass index (BMI), and comorbid conditions such as hypertension.…”

“…While the prevalence of PN varies according to the types of criteria used for diagnosis, population demographics, stage of disease, and other variables, database reviews and meta-analyses estimate that between 30% and 70% of PWH and 10% and 90% diabetes cases are complicated by PN at any given time [4]. The most common type of PN among patients with HIV or diabetes is distal sensory peripheral neuropathy (DSPN), also called distal symmetric polyneuropathy, characterized by progressive dysfunction of length-dependent sensory peripheral nerves [1,[4][5][6][7][8][9]. Damage to large-and small-fiber neural networks cause a range of symptoms starting in the toes and feet, such as tingling, prickling, and discomfort, that increase over time in a symmetric, bilateral "stocking-glove" distribution involving the legs, hands, and arms.…”