Polyneuropathy induced by HIV disease and antiretroviral therapy

Abstract Objective To investigate the underlying mechanisms of polyneuropathy induced by HIV infection or antiretroviral drugs. Methods We tested 100 HIV patients (59 with AIDS). Ninety-three patients received antiretroviral drugs. Forty-four were treated with neurotoxic compounds (ddI, ddC, d4T). Nerve conduction velocities and the sympathetic skin response (SSR) in palms and soles were measured in all patients. In skin biopsies (ankle and thigh), the intraepidermal nerve fiber density (IENFD) and the number of epidermal fibers without contact to the basal membrane (fragments) were quantified using PGP9.5 staining. Results Severity of the disease (CD4 + count) correlated to conduction velocities of peroneal ( p p p p p  > 0.3) but correlated to reduced IENFD in the ankle ( r  = −0.24, p Conclusions Neurotoxic treatment appears to primarily impair thin fiber conduction, whereas HIV neuropathy is linked to large fiber impairment and reduction of fragments of nerve fibers. Significance These findings emphasize the differential pattern of polyneuropathy in HIV patients caused by the infection or induced by antiretroviral treatment.