Peripheral neuropathy, prevalence

Prevalence and Risk Factors of HIV-Associated Peripheral Neuropathy... 

There is a similar high prevalence of peripheral neuropathy (34%) in the pediatric population infected with HIV (Araujo et al. 2000). The frequency of IDP in the HIV-infected population is unknown but is thought to be rare (Wulff et al. 2000). In an outpatient population of HIV positive patients, mononeuritis multiplex and lumbosacral polyradiculopathy were found in less than 1% of patients with AIDS (Fuller et al. 1993). HIV-associated autonomic nervous system dysfunction is also not uncommon as up to 66% of patients have papillary involvement and 15% have sympathetic and parasympathetic involvement causing orthostatic hypotension and respiratory sinus arrhythmia (Gluck et al. 2000). 

Skopehtis EE, Kokotis PI et al (2006) Distal sensory polyneuropathy in HIV-positive patients in the HAART era an entity underestimated by clinical examination. Int J STD AIDS 17(7) 467-472 Smyth K, Affandi JS et al (2007) Prevalence of and risk factors for HIV-associated neuropathy in Melbourne, Australia 1993-2006. HIV Med 8(6) 367-373 Snider WD, Simpson DM et al (1983) Neurological complications of acquired immune deficiency syndrome analysis of 50 patients. Ann Neurol 14(4) 403-418 So YT, Olney RK (1994) Acute lumbosacral polyradiculopathy in acquired immunodeficiency syndrome experience in 23 patients. Ann Neurol 35(l) 53-58 So YT, Holtzman DM et al (1988) Peripheral neuropathy associated with acquired immunodeficiency syndrome. Prevalence and clinical features from a population-based survey. Arch Neurol 45(9) 945-948... 

In combination with other antiretroviral agents, stavudine has caused fatal lactic acidosis in some patients. It is also associated with motor weakness in which case it should be discontinued. Peripheral neuropathy is the most common toxicity associated with stavudine, which is more prevalent at high doses (4mg/kg per day). Neuropathy in these patients generally is associated with numbness, tingling or pain in feet or hands. Patients treated with the combination of stavudine and didanosine may also exhibit liver function abnormalities (hepatic steatosis) and pancreatitis. It may also be associated with the etiology of HIV lipodystrophy syndrome. 

Kelly JJ, Jr, Kyle RA, O Brien PC, Dyck PJ. Prevalence of monoclonal protein in peripheral neuropathy. Neurology 1981 31(11) 1480—1483. 

Nobile-Orazio E, Barbieri S, Baldini L, Marmiroli P, Carpo M, Premoselli S, et al. Peripheral neuropathy in monoclonal gammopathy of undetermined significance Prevalence and immunopathogenetic studies. Acta Neurol Scand 1992 85(6) 383—390. 

Peripheral neuropathy may be the most frequent neurologic disorder associated with HIV infection (Cherry et al., 2005). Its symptoms cause substantial morbidity and discomfort to patients with AIDS. A 30%-35% prevalence of peripheral neuropathy has been documented in patients with HIV infection, but autopsy-based studies have found it in nearly 100% of patients who died of AIDS. The most common peripheral neuropathy associated with HIV occurs in the later stages of HIV disease, usually after the patient has had other AIDS defining illnesses. Symptoms of HIV-associated sensory neuropathies are almost identical to those of other sensory neuropathies. Both distal sensory neuropathy due to HIV infection (seen mainly in late disease) and antiretroxdral toxic neuropathy occur, or sensory neuropathy is caused by a combination of both (Cherry et al., 2005). 

Several medical studies are presented in Table X which have been conducted in groups outside of the industrial sector. In a medical study of exposed Seveso subjects, the prevalence of peripheral neuropathy was three times higher among those exposed persons with chloracne (57). In a study of Missouri residents from a mobile home park with soil contamination with 2,3,7,8-TCDD, some parameters of immune response were reported to differ between the exposed and unexposed (58). The U.S. Air Force completed a comprehensive medical study of the personnel of Operation Ranch Hand, the individuals who sprayed Agent Orange in Vietnam (50). Increased prevalence of enlarged livers and an increase of basal and squamous cell carcinomas was observed. 

TTX can result in peripheral neuropathy, although this disorder is uncommon. The prevalence is generally low, depending on the duration of the condition, which is thought to be about 5% clinically, but increases to 8% in subchnical cases (Roquer and Cano, 1993). Nerve entrapment, similar to hypothyroidism, can also occur. The most common is median nerve compression, commonly known... 

With these reservations in mind, the frequency of symptomatic neuropathy seems to be 15-20% in unselected diabetes patient populations, whereas the frequency of more or less pronounced abnormalities in the peripheral nervous system varies between 20% and 50%, depending on the methodology applied. The prevalence in type 2 diabetes seems to be higher than in type 1 diabetic patients although data are somewhat contradictory [11]. At the onset of diabetes the frequency of nervous system abnormalities is 5-10%, increasing linearly as a function of duration of diabetes and amounts to 50% of the population after 25 years duration of diabetes. Ten to twenty per cent of patients with peripheral diabetic neuropathy will have painful diabetic neuropathy that requires treatment. 

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