Sensory neuropathy not only affects the quality of life, but is frequently under-treated, even by expert HIV providers. In addition, the development of neuropathic symptoms, or even the fear of sensory neuropathy, may reduce adherence with antiretrovirals. Finally, peripheral neuropathy may actually be an early marker of mitochondrial dysfunction, which is now believed to contribute to the development of lipodystrophy, lactic acidosis, and other toxicities. The clinical features of HIV sensory neuropathy and dideoxynucleoside toxicity overlap.
Weakness is almost never a presenting symptom.
Motor findings are uncommon, with only a third of patients having distal weakness. In practical terms, the definition of dideoxynucleoside toxic sensory neuropathy is made when the neuropathic symptoms develop while an individual is on a dideoxynucleoside-containing regimen. There is prominent macrophage activation, both within the dorsal root ganglia and in a multifocal pattern along the peripheral nerve. Research in Human Nervous System. In the last few years, punch skin biopsy has been shown to be a sensitive and reliable technique to demonstrate damage within small unmyelinated nerve fibers terminating within the epidermis.