Polyneuropathy induced by HIV disease and antiretroviral therapy |
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Authors: | Panagiotis Kokotis Martin Schmelz Georgios K. Papadimas Elias E. Skopelitis Kyriaki Aroni Theodore Kordossis Nikolaos Karandreas |
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Affiliation: | 1. Department of Neurology, Aeginition Hospital, Medical School of Athens, Athens, Greece;2. Department Anesthesiology Mannheim, University of Heidelberg, Germany;3. Pathophysiology (AIDS Unit), “Laikon” General Hospital, Medical School of Athens, Athens, Greece;4. Department of Pathology, “Laikon” General Hospital, Medical School of Athens, Athens, Greece |
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Abstract: | ObjectiveTo investigate the underlying mechanisms of polyneuropathy induced by HIV infection or antiretroviral drugs.MethodsWe 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.ResultsSeverity of the disease (CD4 + count) correlated to conduction velocities of peroneal (p < 0.01, Spearmans rank correlation), sural (p < 0.01) and median nerves (p < 0.05/p < 0.001, sensory/motor). In contrast, the duration of neurotoxic treatment did not impair conduction velocities (p > 0.3) but correlated to reduced IENFD in the ankle (r = ?0.24, p < 0.05). Despite their reduced IENFD, patients with long neurotoxic treatment had a high number of fragments irrespective of their CD4 + count.ConclusionsNeurotoxic treatment appears to primarily impair thin fiber conduction, whereas HIV neuropathy is linked to large fiber impairment and reduction of fragments of nerve fibers.SignificanceThese findings emphasize the differential pattern of polyneuropathy in HIV patients caused by the infection or induced by antiretroviral treatment. |
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