Bulletin of Experimental Treatments for AIDS, No. 3, June 1989
Etienne Hafs and Ron Baker

** Reported by UCSF researchers Dale Bredesen and Raphael Stricker at the annual meeting of the American Academy of Neurology. Chicago, April, 1989.

In people with HIV infection, approximately one third of neuropathies are caused by infections such as CMV or other viruses of the herpes family.

** Miller RG, et al. Peripheral Nervous System Dysfunction in AIDS. AIDS in the Nervous System 1988. p.65.

If diagnosed early, some of these neuropathies may be treatable. In other neuropathies, HIV or other pathogens* may cause the body to trigger an autoimmune response* against its own nerve tissue. Antibodies to peripheral* nerve tissue have been found in individuals with HIV related peripheral neuropathies*. The precise role of the antibodies is still unclear, but they may be important in producing these neuropathies.

** Kiprov D, et al. Antibody mediated peripheral neuropathies associated with ARC and AIDS: successful treatment with plasmapheresis. Journal of Clinical Apheresis , vol 4, p.6, 1988.

Symptoms

Symptoms of peripheral nervous system (PNS) disorders vary widely. Most people with peripheral neuropathy first notice numbness or tingling in the toes. Over a period of weeks or months the symptoms may gradually spread to the fingers.

** Miller RG, et al. p. 65.A

Individuals often report severe pain along the course of a nerve (neuralgia), especially in the feet. This can make walking difficult or impossible. Muscles in the feet and calves may cramp, causing sleeplessness. As the neuropathy progresses, individuals may become tired and lose their balance.

** Ibid

Distal symmetric peripheral neuropathy (DSPN) is the most common syndrome among people with generalized neuropathy. The feet and lower legs may show hair loss, thinning of the skin, or redness. In most cases, weakness in the foot muscles is mild, but can be severe. Loss of feeling begins in the toes and gradually spreads upward.

The symptoms of chronic inflammatory demyelinating* polyradiculoneuropathy (CIDP) resemble those of Guillain Barr syndrome*, except that CIDP usually gets worse over time and lasts for a long time.

** Ibid

Individuals usually have significant weakness in muscles of the feet, legs, arms, and hands. Sensory abnormalities in hands and feet are mild compared with the muscle weakness.

Mononeuritis multiplex (MM) is less common than DSPN or CIDP. Usually symptoms of MM start suddenly. Individuals experience abnormal sensations over the face, legs arms or trunk of the body. Cranial nerves are commonly affected.

** Lipkin WI, et al. Inflammatory neuropathy in homosexual men with lymphadenopathy. Neurology , 35:1479 1483, 1985.

Diagnosis

Diagnosis is usually made by some combination of the follow- ing:

1) Patient's description of symptoms.

2) Physical examination.

3) Laboratory tests, especially of the blood and cerebrospinal fluid.

4) Electromyography (electrical stimulation of the muscles).

5) Muscle biopsy.

6) Nerve biopsy.

Natural History

The course of neuropathies varies widely from patient to patient and from syndrome to syndrome. Some individuals with DSPN improve or stabilize without treatment. Some people with MM go on to develop CIDP. In most cases, CIDP progresses slowly, but relentless progression is more likely in patients with severe opportunistic infections and/or wasting syndrome.

Treatments

Determining the most effective treatment depends on the type of neuropathy in each case. Plasmapheresis has been shown effective for individuals with CIDP (see article below). There is no specific treatment for DSPN, but some antidepressants (e.g., elavil) can be helpful in reducing nerve pain. CMV is responsible for a progressive polyradiculopathy which is usually fatal, but a recent study suggests that if the syndrome is recognized early and treated with ganciclovir* within 12 days after the onset of symptoms, individuals can recover.

** Miller RG, et al. Successful treatment of progressive polyradiculopathy in AIDS patients. Neurology , 39(1):271, March, 1989.

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