Peripheral neuropathy is a painful condition that is caused by damage to the nerves in the peripheral nervous system, which includes the nerves that run from the brain and the spinal cord to the arms, hands, legs, and feet. The damaged nerves alter sensations and feelings such as pain, temperature, and touch. Peripheral neuropathy occurs frequently with HIV disease and can result in a great deal of pain. It greatly impacts the quality of life of an HIV positive person, often leading to isolation and depression. It is reported in approximately 1/3 of patients who are AIDS diagnosed, but it can occur at any stage of HIV disease including the acute seroconversion stage and the latent (asymptomatic) period.
Causes of peripheral neuropathy:
Peripheral neuropathy is often a side effect of the medications used to treat HIV, but can also be caused by HIV infection itself. Neuropathy can also be caused by vitamin deficiencies (vitamin B12, folate), diabetes, or thyroid abnormalities. Alcohol abuse, older age (greater than 50), and low CD4+cell counts are also assosiated with an increased incidence of peripheral neuropathy.
Drugs that cause peripheral neuropathy:
Symptoms of peripheral neuropathy:
The earliest symptoms of peripheral neuropathy are pain, numbness, and tingling in the hands and feet in the classic “sock and glove” distribution. The pain is often described as burning, shooting, electric-shock like, throbbing, or aching. Some people describe an altered sensation when picking up objects, as if their fingers are “made of plastic”, or feelings of their hands and feet falling asleep. The patient may complain of their feet throbbing or cramping at night or of stumbling when they try to walk. The symptoms are generally symmetric (occur on both sides of the body), although they may be more severe on one side. If the neuropathy is severe, touching the affected extremity can feel like an open wound is being touched. In the most severe cases, severe pain and dysfunction of the nerves can result in difficulty walking and disability.
Diagnosis of peripheral neuropathy:
The diagnosis of peripheral neuropathy can generally be made by a healthcare provider who is experienced in the treatment of HIV disease based on a history of the symptoms and a comprehensive physical examination which includes testing of the reflexes and evaluation of the sense of vibration,touch, pressure, and pain in the extremities. Bloodwork will be done to check CD4+ cell count, HIV viral load, blood glucose (sugar), thyroid function, Vitamin B1, B6, and B12 levels, folate levels, Vitamin E levels, and Magnesium levels. The HIV specialist may refer the patient to a neurologist for an evaluation and treatment recommendations, and nerve-conduction studies (electromyography, or EMG) may be scheduled.
Treatment of peripheral neuropathy:
Unfortunately, there iss no cure for peripheral neuropathy. They key to treatment is to remove the underlying cause and to control the pain.
Medications used to treat peripheral neuropathy:
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