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Neurological Complications of HIV in The Peripheral Nervous System 

Neurological Complications of HIV in The Peripheral Nervous System
Chapter:
Neurological Complications of HIV in The Peripheral Nervous System
Author(s):

John R Keltner

, Cherine Akkari

, and Ronald J Ellis

DOI:
10.1093/med/9780199392742.003.0027
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date: 23 October 2019

HIV sensory neuropathy affects approximately 50% of persons diagnosed with HIV and, in 40%, results in disabling symptoms including paresthesia and/or pain. This chapter focuses on providing guidance to psychiatrists in the clinical management of pain in persons with HIV and sensory neuropathy. The differential diagnostic evaluation of HIV sensory neuropathy, other peripheral neuropathies, and spinal cord mimics and management of HIV sensory neuropathy are reviewed, as well as management of HIV distal neuropathic pain. The differential diagnostic evaluation of peripheral neuropathies is simplified using a graphical decision tree. The chapter also reviews the pathophysiology of HIV sensory neuropathy and warning signs of advanced disease. Procedures to diagnose HIV sensory neuropathy, including nerve conduction studies and electromyography, quantitative sensory testing, skin biopsy, and the autonomic sweat test are discussed, as are clinical aspects of HIV distal neuropathic pain. The chapter addresses the impact of HIV distal neuropathic pain on quality of life and depression and concludes with a discussion of treatments for HIV distal neuropathic pain.

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