Annals of Clinical Neurophysiology

The Korean Society of Clinical Neurophysiology (대한임상신경생리학회)
권호 표지

Peripheral Neuropathy Associated with Human Immunodeficiency Virus Infection

사람면역결핍바이러스 감염과 연관된 말초신경병증

  • Lee, Min Hwan (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Young-Min (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Pyun, So Young (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jimin (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Kwang-Kuk (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine)
  • 이민환 (울산대학교 의과대학 신경과학교실) ;
  • 임영민 (울산대학교 의과대학 신경과학교실) ;
  • 변소영 (울산대학교 의과대학 신경과학교실) ;
  • 김지민 (울산대학교 의과대학 신경과학교실) ;
  • 김광국 (울산대학교 의과대학 신경과학교실)
  • Received : 2012.05.09
  • Accepted : 2012.06.01
  • Published : 2012.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Peripheral neuropathy is the most frequent neurological complication in human immunodeficiency virus (HIV) infection, related with diverse etiologies including inflammation, opportunistic infection and side effects of medications. The purpose of the present study was to evaluate characteristics of HIV associated neuropathy according to the stage of HIV infection. Methods: In reviewing the medical records of HIV patients who underwent electrodiagnostic studies between 1997 and 2011, total 11 patients (all males; median age, 47 years; range, 28-71 years) with comorbid neuropathy were enrolled. Stage of HIV infection was categorized according to the Centers for Disease Control and Prevention (CDC) criteria. Classification of peripheral neuropathy was based on clinical and electrophysiological features. Results: Distal symmetric polyneuropathy was observed in 8 patients (72.7%), inflammatory demyelinating polyneuropathy in 2 patients (18.1%), and polyradiculopathy in 1 patient (9.1%). Median CD4+ T cell count was $123/mm^3$ (range, $8-540/mm^3$) and 7 patients (60%) had the most advanced HIV disease stage (CDC-C3). There was no neuropathy caused by CMV infection. Conclusions: Distal symmetric polyneuropathy was the most common type of neuropathy in HIV infection, but various forms of neuropathy such as inflammatory demyelinating polyneuropathy and polyradiculopathy were also present. HIV associated neuropathy is more frequently associated with advancing immunosuppression, although it can occur in all stages of HIV infection.

Keywords

References

  1. Korea Centers for Disease Control and Prevention. Infection disease reference information [Internet]. Seoul(KR) [cited 2011 Aug 10]. Available from: http://cdc.go.kr/kcdchome/jsp/observation/ stat/pop/stat_pop03.html.
  2. Snider WD, Simpson DM, Nielsen S, Gold JW, Metroka CE, Posner JB. Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 1983; 14:403-418.
  3. Hall CD, Snyder CR, Messenheimer JA, Wikins JW, Robertson WT, Whaley RA, et al. Peripheral neuropathy in a cohort of human immunodeficiency virus-infected patients. Incidence and relationship to other nervous system dysfunction. Arch Neurol 1991;48:1273-1274.
  4. Bacellar H, Munoz A, Miller EN, Cohen BA, Besley D, Selnes OA, et al. Temporal trends in the incidence of HIV-1-related neurologic diseases: Multicenter AIDS Cohort Study, 1985-1992. Neurology 1994;44:1892-1900.
  5. Hwang HY, Chang HH, Kim SW, Rye SY, Kim HI, Park GY, et al. Prevalence and Risk Factors for HIV-associated Peripheral Sensory Neuropathy in HIV-infected Adults in Daegu, Korea. Chonnam Med J 2009;45:161-167.
  6. Kim HJ, Kim SY, Lee KB, Lee KW, Oh MD, Choe KW. Neurologic Complications of Human Immunodeficiency Virustype 1 Infection. J Korean Med Sci 2003;18:149-157.
  7. Tagliati M, Grinnell J, Godbold J, Simpson DM. Peripheral nerve function in HIV infection: clinical, electrophysiologic, and laboratory findings. Arch Neurol 1999;56:84-89.
  8. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison's principles of internal medicine. 17th ed. McGraw-Hill Professional, 2008; 1107-1113.
  9. Simpson DM, Olney RK. Peripheral neuropathies associated with human immunodeficiency virus infection. Neurol Clin 1992;10:685-711.
  10. Wulff EA, Wang AK, Simpson DM. HIV-associated peripheral neuropathy: epidemiology, pathophysiology and treatment. Drugs 2000;59:1251-1260.
  11. Robinson-Papp J, Simpson DM. Neuromuscular diseases associated with HIV-1 infection. Muscle Nerve 2009;40: 1043-1053.
  12. Berger AR, Arezzo JC, Schaumburg HH, Skowron G, Merigan T, Bozzette S, et al. 2', 3'-dideoxycytidine (ddC) toxic neuropathy: a study of 52 patients. Neurology 1993;43:358-362.
  13. Simpson DM, Tagliati M. Nucleoside analogue-associated peripheral neuropathy in human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 9:153-161.
  14. Preston DC, Shapiro BE. Electromyography and Neuromuscular disorders Clinical-Electrophysiologic Correlations. 2nd ed. ELSEVIER, 2005;389-391.
  15. Cornblath DR, McArthur JC, Kennedy PG, Witte AS, Griffin JW. Inflammatory demyelinating peripheral neuropathies associated with human T-cell lymphotropic virus type III infection. Ann Neurol 1987;21:32-40.
  16. Simpson DM, Tagliati M. Neurologic manifestations of HIV infection. Ann Intern Med 1994;121:769-785.
  17. Brannagan TH, Zhou Y. HIV-associated Guillain-Barre syndrome. J Neurol Sci 2003;208:39-42.
  18. Parry O, Mielke J, Latif AS, Ray S, Levy LF, Siziya S. Peripheral neuropathy in individuals with HIV infection in Zimbabwe. Acta Neurol Scand 1997;96:218-222.
  19. Verma A. Epidemiology and clinical features of HIV-1 associated neuropathies. J Peripher Nerv Syst 2001;6:8-13.
  20. Corral I, Quereda C, Casado JL, Cobo J, Navas E, Perez-Elias MJ, et al. Acute polyradiculopathies in HIV-infected patients. J Neurol 1997;244:499-504.
  21. de Gans J, Portegies P, Tiessens G, Troost D, Danner SA, Lange JM. Therapy for cytomegalovirus polyradiculomyelitis in patients with AIDS: treatment with ganciclovir. AIDS 1990; 4:421-425.
  22. So YT, Olney RK. Acute lumbosacral polyradiculopathy in acquired immunodeficiency syndrome: experience in 23 patients. Ann Neurol 1994;35:53-58.
  23. Deshpande AK, Patnaik MM. Nonopportunistic neurologic manifestations of the human immunodeficiency virus: an Indian study. J Int AIDS Soc 2005;7:2.
  24. Jo YJ, Yim YB, Kim DS, Jung DS, Park KH. A Case of Cytomegalovirus Lumbosacral Polyradiculopathy in Acquired Immune Deficiency Syndrome. J Korean Neurol Assoc 1998; 16:408-412.