Neuropathy in Human Immunodeficiency Virus: A Review of the Underlying Pathogenesis and Treatment

Abstract

This article explores the various causes of the human immunodeficiency virus (HIV), and its associated neuropathy, including the effects of HIV on the nervous system and the long-standing therapy that is often provided to patients with HIV. Several studies regarding the neurotoxic effects of combined antiretroviral therapy (cART) and HIV were reviewed and various hypotheses were discussed. Furthermore, we present the nature of HIV-sensory neuropathy (HIV-SN) among different demographic populations and their subsequent risk factors predisposing them to this condition. It was observed that the incidence of the disease increases in increased survival of the patients as well as in males. Finally, the current approach to HIV-SN and its overlapping features with other causes of peripheral neuropathy have been discussed which demonstrates that a clinical examination is the most important clue for a healthcare professional to suspect the disease. Our main aim was to study the current perspectives and guidelines for diagnosing and managing a patient with HIV-SN to reduce disease prevalence and bring about a more aware frame of mind when following up with an HIV patient.

Glutathione in HIV-Associated Neurocognitive Disorders

“…For many with HIV peripheral neuropathy, symptoms do not improve with typical treatments. Atypical treatments, such as cannabis, recombinant human nerve growth factor, and topical capsaicin, each have their own limitations (whether legal, financial, or efficacious) [ 97 ]. As a result, L-GSH may be a useful therapy to consider in these patients as well.…”

Understanding Lamotrigine’s Role in the CNS and Possible Future Evolution

“…However, these trials typically had small sample sizes and significant dropout rates [ 84 ]. Nowadays, LTG is occasionally used for painful HIV-related neuropathy; however, it is not frequently prescribed for neuropathic pain because it fits into the spectrum of medications used to treat different types of neuropathic pain [ 85 ]. Regarding fibromyalgia, a chronic pain disorder characterized by widespread musculoskeletal pain and tenderness, although lamotrigine has been suggested to improve pain and quality of life in individuals with fibromyalgia, there have been no studies specifically examining its efficacy in this condition.…”

Toxic Neuropathies

“…Nucleoside analogues or antiretroviral medications are regularly used to treat and prevent HIV and acquired immunodeficiency syndrome (AIDS) as they inhibit reverse transcriptase, preventing viral replication. Older antiretroviral drugs such as stavudine, didanosine, and zalcitabine have the strongest association with a subacute length-dependent sensory greater than motor axonal neuropathy 72,73 . It is often difficult to distinguish between HIV neuropathy and antiretroviral therapy-related neuropathy; however, signs of systemic antiretroviral therapy toxicity, including elevated lactate levels, lipodystrophy, and myopathy, can help differentiate the two diagnoses.…”

“…Older antiretroviral drugs such as stavudine, didanosine, and zalcitabine have the strongest association with a subacute length-dependent sensory greater than motor axonal neuropathy. 72,73 It is often difficult to distinguish between HIV neuropathy and antiretroviral therapy-related neuropathy; however, signs of systemic antiretroviral therapy toxicity, including elevated lactate levels, lipodystrophy, and myopathy, can help differentiate the two diagnoses. In these cases, it is important to look for other signs of toxicity.…”