Diagnosing and treating HIV-associated sensory neuropathy: a global perspective

Pain Manag. 2016 Apr;6(2):191-9. doi: 10.2217/pmt.15.65. Epub 2016 Mar 18.

Abstract

HIV-associated sensory neuropathy (HIV-SN) is a common complication of HIV and remains highly prevalent even with modern HIV management strategies, causing debilitating pain in millions globally. We review HIV-SN diagnosis and management. We suggest most HIV-SN cases are easily recognized using clinical screening tools, with physician assessment and/or specialized testing prioritized for atypical cases. Management aims to prevent further nerve damage and optimize symptom control. Symptom relief is difficult and rarely complete, with a lack of proven pharmacological strategies. Work is needed to clarify optimal use of available medications. This includes understanding the marked placebo effect in HIV-SN analgesic trials and exploring 'responder phenotypes'. Limited data support nondrug strategies including hypnosis, meditation, psychology, physical activity and a positive therapeutic relationship.

Keywords: HIV; neuropathic pain; neuropathy; nondrug strategies; placebo effect.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Clinical Trials as Topic
  • Global Health
  • HIV Infections / complications*
  • Humans
  • Neuralgia / drug therapy
  • Neuralgia / therapy*
  • Neuralgia / virology
  • Pain Threshold
  • Polyneuropathies / diagnosis*
  • Polyneuropathies / drug therapy
  • Polyneuropathies / therapy*
  • Polyneuropathies / virology