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Another Neuropathy Question!
Feb 6, 2003

For sake of this question lets assume that HIV is not the cause of Peripheral Neuropathy, but rather Anti-viral drugs themselves, lets say Zerit. The mechanisms that are involved in the gradual destruction of the myelin sheath of the nerves is first apparent at the feet (such a distance from the center of neurological activity?) and can travel up the leg and also affect the hands. Are other nerves at risk for the same progressive degeneration (facial, dorsal etc..) if yes at what stage If no why are these nerves spared and only the extreme appendages predominantly affected. Again for this argument we will look to the drugs as the causal factor and not possibly the virus .


Response from Dr. Henry

Toxic neuropathies effect the longest nerves first (spinal cord to toes are the longest) with the distal regions impacted first. More proximal involvement is seen in severe cases late. I usually stop treatment well before there is any involvement of sites more proximal that feet/ankles and fingers. Again, the drug toxicity is a function of amount of exposure (longer = more exposure) and length of the nerve. KH


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