A new study found a high rate of peripheral neuropathy in antiretroviral-naive patients within 3 months after HIV infection.
HIV infection is known to affect both the central and peripheral nervous systems.1 While later stages of neurologic conditions associated with advanced HIV/AIDS have been defined, there is little known about the nature of early peripheral neuropathy during primary HIV infection. The morbidity associated with advanced neuropathy is significant1 and early intervention may help prevent or attenuate long-term effects. Preventive approaches, however, require a better understanding of the prevalence of and mechanisms underlying the neuropathy in early HIV infection.2
A recent study published in the Journal of Acquired Immune DeficiencySyndromes shed some light on this association.2 The study systematically examined patients with primary HIV infection for clinical signs of peripheral neuropathy, defined as 1 or more of the following unilateral or bilateral signs: decreased distal limb position, vibration, or temperature sense or hyporeflexia. Symptomatic peripheral neuropathy was defined as the presence of these signs with symptoms. Blood and cerebrospinal fluid (CSF) analysis was also performed to assess specific markers of viral replication and immune activation.2
The study included 58 antiretroviral therapy (ART)-naive male subjects without diabetes, of whom 20 (35%) met clinical criteria for peripheral neuropathy when evaluated at a median of 107 days post–HIV transmission. More than two-thirds of these patients met criteria for symptomatic peripheral neuropathy and 6 (30%) for bilateral neuropathy.2 There were no differences in median age, days post–HIV transmission, blood CD4+ or CD8+ T lymphocyte count, CSF or plasma HIV RNA levels, CSF white blood cell count, or CSF to blood albumin ratio between patients who developed peripheral neuropathy and those who did not. Subjects with peripheral neuropathy had a higher percentage of activated phenotype CSF CD8+ cells (P =.009) and also higher levels of CSF neopterin (P = .003), CSF monocyte chemoattractant protein-1 (P = .006), and blood neopterin (P = .006) than those who did not.2 The results indicate an association of increased nervous system inflammation with peripheral neuropathy.
The study demonstrates a high rate of peripheral neuropathy in ART-naive individuals within the first months after HIV infection. In primary care practice, presenting symptoms of peripheral neuropathy could support more aggressive screening for HIV infection.2