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Ask the Doctor: How Can You Prevent HIV-Related Peripheral Neuropathy?

February 22, 2012

Theresa Mack, M.D., M.P.H.

Every month, HIV specialist Theresa Mack, M.D., M.P.H.--an associate medical director at St. Luke's Medical Group in Harlem, N.Y.--will answer your most pressing HIV/AIDS questions.

Doctors use the term "peripheral neuropathy" to describe inflammation of the peripheral nerve, which carries information to and from the central nervous system--made up of the brain and the spinal cord--and to the organs and periphery of the body: the arms, legs, hands and feet.

Peripheral neuropathy can be caused by:

  • HIV
  • Older ARV agents d4T, ddI and DDC--called "D" drugs
  • Other drugs, such as isoniazid, dapsone and metronidazole
  • Chronic diseases, such as diabetes and kidney disease
  • Alcoholism
  • Vitamin B6 or B12 deficiency

These factors can put you at risk:

  • Previous HIV or AIDS diagnosis
  • A low CD4 count, usually less than 200
  • Exposure to d4T, ddI or DDC
  • Opportunistic infection accompanying an AIDS diagnosis
  • Uncontrolled diabetes or kidney disease
  • Cancer medications vincristine and cis-platinum
  • Alcohol
  • Anti-alcohol drugs, such as disulfiram, used in rehab to discourage clients from drinking
  • Vitamin B6 or B12 deficiency
  • Anticonvulsants, such as phenytoin
  • The heart or blood pressure medications amiodarone and hydralazine
  • The infection-fighting drugs (antibiotics) metronidazole, nitrofurantoin, isoniazid and dapsone

No screening tests exist to diagnose the disease. The only way to know if a person's peripheral nerves are damaged or inflamed is when symptoms develop. Typical symptoms include numbness or burning in the limbs, needlelike sensations, shooting pain or swollen hands and feet. In very advanced peripheral neuropathy, the pain and swelling become so severe that patients become unable to walk or use their hands.

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If you experience any of these signs, inform your physician right away so that a cause can be determined. The peripheral neuropathy will worsen if nothing is done. If diabetes or kidney-disease medication or treatment is the culprit, your doctor can adjust the medications. However, the possibility exists that the doctor may never discover the true cause of the disease.

Peripheral neuropathy can occur in up to 30 percent of patients living with HIV, and it is difficult to treat the pain, which many patients experience every day. While controlling the virus with ARV drugs does prevent AIDS-related complications, this benefit must be balanced against any side effects that will affect one's quality of life. For example, if no other options exist to control HIV, the doctor may prescribe ddI, one of the older ARVs; however, ddI can cause peripheral neuropathy. This example helps to illustrate why it's important to be familiar with the drugs that your doctor prescribes and to have an open dialogue about the most common adverse reactions to each drug.

Managing peripheral neuropathy typically means consulting with a neurologist and getting an MRI or CAT scan of the head, a muscle-and-nerve test called an EMG and a biopsy of the peripheral nerve.

Anticonvulsive drugs or antidepressants can help control the pain, but they are not 100 percent effective. So doctors often prescribe a combination of pain medications and relaxation techniques (think: yoga), acupuncture, exercise and hot and cold compresses.

As told to Tomika Anderson, a freelance writer based in Brooklyn, N.Y.



  
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This article was provided by Black AIDS Institute. Visit Black AIDS Institute's website to find out more about their activities and publications.
 
See Also
Neurological Complications of AIDS Fact Sheet
More on Neuropathy
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