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HIV sensory neuropathy and pain

With an estimated 33 million people living with HIV, more people gaining access to antiretroviral therapy every day, and HIV–SN prevalence ranging from 20% to 50% or more in cART–treated cohorts, the burden of HIV–SN pain is a problem of enormous global importance. No routinely available therapy has unequivocally been shown to be effective for treating HIV–SN pain. This statement is the introduction of a recent (june 2010) paper on HIV associated sensory and painful neuropathy.

HIV-SN due to HIV or induced by toxicity from antiretroviral drugs (antiretroviral toxic neuropathy [ATN]) share the same clinical characteristics. The loss of thermosensation is characteristic for of a loss of C fibers.

In a review of all clinicat trials the authors state that basically only smoked Cannabis, capsaicine patch 8% and Recombinant Human Nerve Growth Factor (rhNGF) are effective, based on RCT's. All classical drugs such as pregabeline and gabapentine, as well as amitriptyline are not effective according to RCT's.

Tudor J.C. Phillips et al. Painful HIV-Associated Sensory Neuropathy Vol. XVIII, Issue 3 June 2010

Jan M. Keppel Hesselink, MD, PhD, june 2010