Sensory, psychological, and metabolic dysfunction in HIV-associated peripheral neuropathy: A cross-sectional deep profiling study

Abstract

SummaryStudy participants with HIV-associated sensory polyneuropathy (HIV-SN) had higher plasma triglyceride concentrations, depression, anxiety, catastrophizing scores, and prevalence of insomnia than HIV participants without HIV-SN.

A rodent model of HIV protease inhibitor indinavir induced peripheral neuropathy

“…Furthermore, by using the Neuropathic Pain Symptom Inventory it has been revealed that 42% of participants experiencing painful HIV-SN report symptoms of moderate and severe cold evoked pain, although this is not detected with sensory profiling [40]. Here, we have shown that indinavir-treated rats display increased thigmotaxis in the open field at the time of peak hindpaw mechanical hypersensitivity.…”

“…Indeed, our recent study has shown that participants with painful HIV-SN have reduced quality of life, a higher incidence of insomnia, and increased depression, anxiety, and catastrophizing, when compared to participants without HIV-SN [40].…”

“…This finding is also in contrast with early clinical data showing that patients with HIV-related painful neuropathy do not usually present with thermal hypersensitivity [33]. Our recent study involving a cohort of HIV-infected patients with and without HIV-SN, most of whom had received combinational ART including indinavir, has shown that the most frequent sensory abnormalities demonstrated in the HIV-SN group are loss of mechanical and vibration detection thresholds followed by a significant loss of cold and warm detection thresholds and heat pain threshold when compared to those of neuropathy free HIV positive patients and healthy volunteers, demonstrated by quantitative sensory testing [40].…”

Pain and the global burden of disease

“…The anticipated decline in HIV-SN with withdrawal of neurotoxic antiretroviral drugs is not yet evident, and this peripheral neuropathy still afflicts between 27% and 57% of people living with HIV of whom between 38% and 90% experience neuropathic pain. 8,11,21 Therefore, HIV-SN is one of the most frequent manifestations of HIV in people who are adequately treated with antiretroviral drugs. The burden of neuropathic pain in HIV-SN is further increased as it is peculiarly resistant to analgesic therapies that are effective in other painful neuropathies.…”

Flight Lieutenant Peach’s observations on Burning Feet Syndrome in Far Eastern Prisoners of War 1942–45

“…Cruickshank documented 58.6% of the 500 cases he assessed reported 'sharp', 'shooting' pain. 3,4,6,7 The pain symptom descriptors which feature in Peach's and other accounts are also prominent in modern day profiles of patients with painful neuropathies including HIV-associated sensory neuropathy 24 and diabetic neuropathy, which has been reported as 'distal, symmetrical, often associated with nocturnal exacerbations, and commonly described as prickling, deep aching, sharp like an electric shock, and burning' 25 ; corresponding with the descriptions given of BFS. For a grading of 'probable' neuropathic pain there is an additional requirement relating to sensory examination: 'sensory signs in the same neuroanatomically plausible distribution as pain'.…”