Hiv1associated Peripheral Neuropathy Syndromes

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Inflammatory polyneuropathy

Acute

Chronic

Distal symmetrical polyneuropathy Progressive polyradiculopathy Mononeuritis multiplex AUTONOMIC NEUROPATHY SENSORY GANGLIONITIS MOTOR NEURON DISEASE

the time patients develop AIDS, clinical and electrophysiological evidence of neuropathy is present in up to one third of patients 137] and an even higher rate of nerve pathology is reported from autopsy studies. Data from the Multicenter AIDS Cohort Study indicate that the frequency of neuropathy in AIDS increased between 1985 and 1992.[98]

Acute demyelinating polyneuropathy, brachial plexopathy, and mononeuritides may occur at the time of acute infection or seroconversion. Acute inflammatory demyelinating polyneuropathy (AIDP) and chronic inflammatory demyelinating neuropathy (CIDP), although rare, are the most common form of peripheral neuropathy during the latent, asymptomatic, or mildly symptomatic stage of HIV- 1 disease when CD4+ cell counts are greater than or equal to 500 cells/mm. 3 As immunodeficiency progresses and as CD4+ cell counts decline to the 200 to 500 cells/ mm3 range, the most frequent neuropathies encountered are mononeuritis multiplex and herpes zoster neuropathy. With HIV-1 disease progression (CD4+ cell counts are less than 200 cells/mm 3 ), the occurrence of distal symmetrical polyneuropathy increases, as does the prevalence of other types of neuropathies such as autonomic neuropathy, mononeuritis multiplex, cranial mononeuropathies, mononeuropathies-radiculopathies associated with neoplasms, and toxic neuropathies. Progressive polyradiculopathy occurs in advanced HIV-1 disease when the patient is severely immunosuppressed (CD4+ counts less than 50 cells/mm3 ).

INFLAMMATORY DEMYELINATING POLYNEUROPATHIES

Although they are relatively uncommon, both acute AIDP and chronic CIDP are well-recognized complications of HIV-1 infection. Wi Unlike other HIV-associated neuropathies, the inflammatory neuropathies occur primarily in patients early in the course of the illness before AIDS develops. Acute inflammatory demyelinating polyneuropathy, in particular, may occur coincidentally with seroconversion. '139] This syndrome may uncommonly occur in the early stages of the disease when CD4+ cell counts are high.

TABLE 44-12 -- HIV-1-ASSOCIATED PERIPHERAL NEUROPATHIES: CLINICAL FEATURES

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