|ARV Toxic Neuropathyb
- Variable, weeks to months following NRTI initiation
- Decreased sensation
- Aching, burning, painful numbness
- Hyperalgesia (lowered pain threshold)
- Allodynia (non noxious stimuli cause pain)
- Decreased or absent ankle reflexes
- Bilateral soles of feet, ascending to legs and fingertips
HIV-Infected Adults on d4T:
- 1.13% prevalence (baseline 2001); incidence 0.23 per 100 person-years (2001–2006) in a U.S. cohort.
- <1% discontinued d4T because of neuropathy in 3 large African cohorts (aged 1 month–18 years; median follow-up 1.8–3.2 years).
- Prevalence up to 57%
- Incidence rates 6.4–12.1 per 100 person-years
- Pre-existing neuropathy (e.g., diabetes, alcohol abuse, vitamin B12 deficiency)
- Elevated triglyceride levels
- Older age
- Poor nutrition
- More advanced HIV disease
- Concomitant use of other neurotoxic agents (e.g., INH)
- Some mitochondrial DNA haplogroups may have increased risk
|Limit use of d4T and ddI, if possible.
As part of routine care, monitor for symptoms and signs of peripheral neuropathy.
|Discontinue offending agent.
Persistent pain can be difficult to treat; topical capsaicin 8% may be helpful.
Data are Insufficient to Allow the Panel to Recommend Use of any of the Following Modalities in Children:
Consider referral to neurologist.
- tricyclic antidepressants