HIV-sensory neuropathy (HIV-SN) remains a common complication of
HIV infection and may be associated with significant morbidity due to
neuropathic pain. The overall purpose of this review is to discuss trends in the changing epidemiology in HIV-SN, new data regarding the pathophysiology of the condition, and discuss approaches to management.
RECENT FINDINGS: While HIV-SN has been historically considered the most common neurological complication of
HIV infection, improved accessibility to effective
combination antiretroviral therapy (cART), use of less neurotoxic antiretroviral medication regimens, and trends towards earlier introduction of treatment have impacted the condition: overall incident HIV-SN is likely decreased compared to prior rates and patients afflicted by HIV-SN may more frequently have asymptomatic or subclinical disease. Traditional predictors of HIV-SN have also changed, as traditional indices of severe immune deficiency such as low CD4 count and high viral load no longer predict HIV-SN. Emerging evidence supports the contention that both peripheral and central mechanisms underlying the generation as well as persistence of
neuropathic pain in HIV-SN exist. It is important to recognize that even mild
neuropathic pain in this clinical population is associated with meaningful impairment in quality of life and function, which emphasizes the clinical importance of recognizing and treating the condition. The general approach to management of
neuropathic pain in HIV-SN is the introduction of symptomatic
analgesic therapy. There exist, however, few evidence-based
analgesic options for HIV-SN based on available clinical data. Symptomatic treatment trials are increasingly recognized to have been potentially confounded by more robust placebo response than that observed in other
neuropathic pain conditions. In the authors' experience, use of
analgesic therapies with proven efficacy in other
neuropathic pain conditions is appropriate, bearing in consideration potential pharmacokinetic interactions with the cART regimen. Combination
analgesic regimens may also achieve meaningful
analgesic responses, particularly when drugs with differing mechanisms of action are utilized. It is paramount that the patient is appropriately counseled regarding expectations and the anticipated benefit of
analgesic therapy, as
pain relief is often incomplete but clinically meaningful improvement in
pain and function can be achieved.