Adverse Neurologic Effects of Antiretroviral Agents

There have been reports of HIV-associated neuromuscular weakness, probably associated with symptomadc lacdc acidosis (Estanislao et al., 2004). Lethal cases have been reported in associadon with stavucUne. Usually the cases have occurred after several months of use of the mecUcadon and have been associated vith sensory motor neuropathy and elevated serum lactate levels. It is tempdng to include this concUdon as another manifestadon of mitochoncUial damage induced by NRTIs. 

Central nervous toxicity has been seen with efavirenz (Clifford et al., 2005). Manifestadons of this process include 

Protease inhibitors are not particularly associated with neurologic side effects but because they tend to cause inhibition of the P450 enzymes, they may alter the metabolism of neurotropic drugs and as a consequence may precipitate neurologic effects (Treisman and Kaplin, 2002). 

Distal sensory peripheral nenropathy (DSPN) has been associated with the nse of ddC, ddl, and stavndine, alone or in combination. The symptoms of this condition inclnde a bnming sensation in feet and hands, nnmbness and tingling in the feet, cramps in the legs, and absent ankle reflexes. The patient may also exhibit decreased sensation to temperatnre, pinprick, vibration, and proprioception (Dieterich, 2003). The symptoms are similar to HIV associated axonal neuropathy. This condition may become irreversible, so it is important to diagnose it earlier. The treatment of choice is symptomatic therapy and discontinuation of the toxic agent when possible. 

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