HIVAssociated Peripheral Neurologic Disease

HIV infection, its complications, and its pharmacologic treatments are associated with a number of peripheral neurologic disorders. Fortunately, the most common of these, HIV neuropathy and drug-induced neuropathy, are chronic processes that do not cause sudden disability or symptoms. HIV-infected patients also have a higher rate of mononeuritis multiplex and an inflammatory myopathy resembling polymyositis.

Occasionally, patients will complain of weakness that progresses over the course of days. Patients in the early stages of HIV infection have greater susceptibility to GBS. The presentation is similar to that of the non-HIV-infected patient, except that a CSF pleocytosis is seen commonly. Such patients should be treated as discussed earlier.

Cytomegalovirus (CMV) Radiculitis In the latter stages of AIDS, patients may suffer from an acute radiculitis caused by CMV infection. These patients almost always have evidence of CMV infection elsewhere in the body and may have ongoing CMV retinitis. Patients become acutely weak, with primarily lower extremity involvement, and may have variable degrees of bowel and bladder dysfunction. The examination shows primarily lower extremity weakness and hyporeflexia, with decreased sensation in the lower extremities and groin. Rectal tone may be impaired. Lumbar puncture reveals a pleocytosis with predominantly polymorphonuclear cells and modestly increased protein; viral DNA is detected by polymerase chain reaction in most patients and is highly specific. MRI of the lumbosacral spine demonstrates swelling and clumping of the cauda equina. Imaging of these patients is mandatory to rule out mass lesions of the lower spine or nerve roots. The treatment of CMV radiculitis is intravenous ganciclovir, started at 5 mg/kg every 12 h for 14 days, which may be initiated prior to definitive diagnosis.

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