Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Management of Medication Toxicity or Intolerance

Peripheral Nervous System Toxicity

Last Updated: May 22, 2018; Last Reviewed: May 22, 2018


  1. Nachman SA, Chernoff M, Gona P, et al. Incidence of noninfectious conditions in perinatally HIV-infected children and adolescents in the HAART era. Arch Pediatr Adolesc Med. 2009;163(2):164-171. Available at
  2. Buck WC, Kabue MM, Kazembe PN, Kline MW. Discontinuation of standard first-line antiretroviral therapy in a cohort of 1,434 Malawian children. J Int AIDS Soc. 2010;13:31. Available at
  3. Ances BM, Vaida F, Rosario D, et al. Role of metabolic syndrome components in HIV-associated sensory neuropathy. AIDS. 2009;23(17):2317-2322. Available at
  4. Banerjee S, McCutchan JA, Ances BM, et al. Hypertriglyceridemia in combination antiretroviral-treated HIV-positive individuals: potential impact on HIV sensory polyneuropathy. AIDS. 2011;25(2):F1-6. Available at
  5. Canter JA, Robbins GK, Selph D, et al. African mitochondrial DNA subhaplogroups and peripheral neuropathy during antiretroviral therapy. J Infect Dis. 2010;201(11):1703-1707. Available at
  6. Phillips TJ, Cherry CL, Cox S, Marshall SJ, Rice AS. Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2010;5(12):e14433. Available at
  7. Menezes CN, Maskew M, Sanne I, Crowther NJ, Raal FJ. A longitudinal study of stavudine-associated toxicities in a large cohort of South African HIV infected subjects. BMC Infect Dis. 2011;11:244. Available at
  8. Wadley AL, Cherry CL, Price P, Kamerman PR. HIV neuropathy risk factors and symptom characterization in stavudine-exposed South Africans. Journal of Pain and Symptom Management. 2011;41(4):700-706. Available at
  9. Tukei VJ, Asiimwe A, Maganda A, et al. Safety and tolerability of antiretroviral therapy among HIV-infected children and adolescents in Uganda. J Acquir Immune Defic Syndr. 2012;59(3):274-280. Available at
  10. Webster LR, Peppin JF, Murphy FT, Tobias JK, Vanhove GF. Tolerability of NGX-4010, a capsaicin 8% patch, in conjunction with three topical anesthetic formulations for the treatment of neuropathic pain. Journal of Pain Research. 2012;5:7-13. Available at
  11. Phan V, Thai S, Choun K, Lynen L, van Griensven J. Incidence of treatment-limiting toxicity with stavudine-based antiretroviral therapy in Cambodia: a retrospective cohort study. PLoS One. 2012;7(1):e30647. Available at
  12. Palmer M, Chersich M, Moultrie H, Kuhn L, Fairlie L, Meyers T. Frequency of stavudine substitution due to toxicity in children receiving antiretroviral treatment in sub-Saharan Africa. AIDS. 2013;27(5):781-785. Available at
  13. Peters RP, Van Ramshorst MS, Struthers HE, McIntyre JA. Clinical assessment of peripheral neuropathy in HIV-infected children on antiretroviral therapy in rural South Africa. Eur J Pediatr. 2014;173(9):1245-1248. Available at
  14. Kaku M, Simpson DM. HIV neuropathy. Curr Opin HIV AIDS. 2014;9(6):521-526. Available at
  15. Sankhyan N, Lodha R, Sharma S, et al. Peripheral neuropathy in children on stauvudine therapy. Indian Journal of Pediatrics. 2015;82(2):136-139. Available at
  16. Chen H, Clifford DB, Deng L, et al. Peripheral neuropathy in ART-experienced patients: prevalence and risk factors. J Neurovirol. 2013;19(6):557-564. Available at
  17. Cherry CL, Wadley AL, Kamerman PR. Diagnosing and treating HIV-associated sensory neuropathy: a global perspective. Pain Manag. 2016;6(2):191-199. Available at
  18. Birbal S, Dheda M, Ojewole E, Oosthuizen F. Adverse drug reactions associated with antiretroviral therapy in South Africa. Afr J AIDS Res. 2016;15(3):243-248. Available at
  19. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1:CD007393. Available at
  20. Centner CM, Little F, Van Der Watt JJ, et al. Evolution of sensory neuropathy after initiation of antiretroviral therapy. Muscle Nerve. 2017. Available at
  21. Smyth K, Affandi JS, McArthur JC, et al. Prevalence of and risk factors for HIV-associated neuropathy in Melbourne, Australia 1993-2006. HIV Med. 2007;8(6):367-373. Available at
  22. Arenas-Pinto A, Thompson J, Musoro G, et al. Peripheral neuropathy in HIV patients in sub-Saharan Africa failing first-line therapy and the response to second-line ART in the EARNEST trial. J Neurovirol. 2016;22(1):104-113. Available at
  23. Aziz-Donnelly A, Harrison TB. Update of HIV-associated sensory neuropathies. Curr Treat Options Neurol. 2017;19(10):36. Available at
  24. Ellis RJ, Marquie-Beck J, Delaney P, et al. Human immunodeficiency virus protease inhibitors and risk for peripheral neuropathy. Ann Neurol. 2008;64(5):566-572. Available at

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