|ARV toxic neuropathyb
Variable, weeks to months following NRTI initiation
Aching, burning, painful numbness
Hyperalgesia (lowered pain threshold)
Allodynia (non-noxious stimuli cause pain)
Decreased or absent ankle reflexes
Distribution: bilateral soles of feet, ascending to legs and fingertips
1.13% prevalence (baseline 2001); 0.23 per 100 person-years (2001–2006)
0.07%–0.26% incidence in two large African cohorts (aged 1 month–18 years, median follow-up 1.8–3.2 years)
17%–57% taking d4T
Pre-existing neuropathy (diabetes, alcohol abuse, vitamin B12 deficiency)
Elevated triglyceride levels
More advanced HIV disease
Mitochondrial DNA haplogroup
|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 safely recommend use of any of the following modalities in children: tricyclic antidepressants, gabapentin, pregabalin, mexilitine, or lamotrigine.