Peripheral Neuropathy in a Third of HIV Patients

Signs of peripheral neuropathy (PN) were detected in a third of men after almost 4 months of HIV, according to research published in the Journal of Acquired Immune Deficiency Syndromes.

A multifaceted team of researchers studied 58 antiretroviral-naïve male patients with laboratory-confirmed HIV infections by examining blood and cerebrospinal fluid (CSF). Study participants were an average age of 36 years with a median CD4+ T-cell count of 575 cells per microliter, which was evaluated at 107 days post-HIV transmission (DPT).

Primary HIV infection (PHI) was used to measure baseline, and was defined as within the first 12 months after HIV transmission. The infection’s timeline was confirmed by observing antibody seroconversion, nucleic acid testing, or less sensitive enzyme immunoassay result. In other cases, DPT was defined by estimating the halfway point between the last negative and first positive HIV test.

Study participants were evaluated based on general medical, neurological, and psychological examinations, PN symptom testing, stricter symptomatic PN (SPN) testing, intravenous drug use, and laboratory assessments. The laboratory testing included blood and CSF testing, lumbar punctures, lymphocyte count measurements, and HIV RNA levels.

The researchers found 20 participants (35%) met criteria for PN after an average of 107 DPT. PN subjects tended to be older (median age 40 years) compared with no PN (NPN) patients (median age 34 years). SPN was found in 13 of those subjects (65%) and 6 patients (30%) had bilateral findings. Seven patients had unilateral findings, and in the remaining 7 subjects, the laterality was not specified.

There was no difference between median ages, days post HIV transmission, blood CD4 or CD8 counts, CSF or plasma HIV RNA levels, CSF white blood cell counts, CSF to blood albumin ratio, or neurological or psychological performances among PN subjects and NPN subjects. Typical symptoms of PN found in 13 PN subjects included “foot tingling and numbness.” No differences were distinguished between NPN and SPN subjects.

However, PN and SPN patients had elevated CSF neopterin, SF monocyte chemoattractant protein-1, and blood neopterin levels when compared to NPN subjects. PN subjects were found to have a higher percentage of activated phenotype CSF CD8+T lymphocytes than NPN study participants.

“PN is a frequent neurological disorder reported in HIV, classically in the setting of chronic untreated HIV infection or after exposure to certain antiretroviral medications,” the authors concluded. “However, we found that signs (35%), or signs and symptoms (22%), of PN were evident in a cohort of ART-naive subjects recruited to a neurological study at a median of 3.5 months after initial HIV transmission. We further examined mechanisms for peripheral nerve dysfunction identified during this stage, revealing that markers of systemic and central nervous system immune activation are elevated in subjects with signs of PN compared with those with NPN.”