Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. Dear Doctor,
My 56 year old mother contracted the virus from my father who died in 1997. My mother has been on anti-retroviral combinations since 2001. She is currently on Nevirapine and Combivir. She has a problem of [the] legs, she says she has a burning sensation in her legs and feet and it really gets annoying at times. Her doctor has said its side effects of medication. Pain killers do not make it any better. Because my mother is in Zimbabwe, they are a bit behind on research.
Is there any information available on this condition and what is it called. Apart from this, she is otherwise healthy and happy, although she tends to get depressed when the legs coninually give her trouble, she says sometimes she feels like giving up.
Trevor Hawkins, M. D.
Associate Clinical Professor, Dept. Family Practice, University New Mexico
Medical Director, Southwest CARE Center, Santa Fe, NM
The condition is called peripheral neuropathy (PN) and it is a problem caused both by the HIV itself and some drugs used to treat HIV. The drugs your mother takes are not the ones usually associated with PN although the 3TC (Epivir) in the Combivir pill may rarely be associated with PN. The worst offenders in this regard are the so-called D drugs; DDI, D4T and DDC.
Most likely, it is the virus itself; many people now think that the virus and the drugs both cause PN by reducing the levels of mitochondrial DNA in the cells; this reduces the amount of oxygen in the cell and the nerve cells in the feet and legs (sometimes the hands) die.
PN is also caused by diabetes and by vitamins B12 or B1 deficiency; make sure these diseases have been excluded as possible causes. Leprosy can also be a cause.
There are no really effective treatments unfortunately. Changing drugs can help; in your mother's case it's unlikely to make much difference but if there is another option she might try changing the 'Epivir'.
A drug called gabapentin (or Neurontin) is our most successful treatment; it is expensive.
Keeping the feet warm helps, plenty of rest, good diet.
We usually start with simple pain killers like acetominophen, then move up to drugs like hydrocodone and then serious narcotics if all else fails (methadone is the cheapest and is effective)
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