title: Association between HIV distal symmetric polyneuropathy and Mycobacterium avium complex infection.
abstract: OBJECTIVE
  Pronounced infiltration of activated macrophages occurs in the peripheral nerves of patients with HIV distal symmetric polyneuropathy (DSPN). Mycobacterium avium complex (MAC) is a common facultative intracellular parasite of the macrophage in advanced HIV disease and may induce macrophage activation. Whether MAC disease is associated with DSPN was examined prospectively.
  
  
  METHODS
  One hundred and fifty consecutive patients with HIV infection were assessed for the probability of DSPN. Blood cultures for MAC were performed, independently of neurological assessment, as part of the investigation of unexplained fever, anaemia, weight loss, or, less commonly, diarrhoea.
  
  
  RESULTS
  There were 20 patients with possible, 14 with probable, and 22 with definite HIV DSPN. Blood cultures for MAC were performed on 80 patients, of whom 39 were positive and 41 negative. The test for trend, when corrected for CD4 count, disclosed a significant association (P = 0.01). There was no statistically significant association between DSPN and cytomegalovirus (CMV) disease.
  
  
  CONCLUSIONS
  Coinfection of the macrophage by MAC may further activate the HIV infected macrophage thereby accelerating the elaboration of neural toxins or MAC infection of the macrophage itself may lead to the production of neural toxins.
authors.affiliation: Department of Neurology, St Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: G R
authors.initials: GR
authors.lastname: Norton
authors.forename: J
authors.initials: J
authors.lastname: Sweeney
authors.forename: D
authors.initials: D
authors.lastname: Marriott
authors.forename: M G
authors.initials: MG
authors.lastname: Law
authors.forename: B J
authors.initials: BJ
authors.lastname: Brew
mesh_terms: D000328:Adult; D005260:Female; D006678:HIV; D006801:Humans; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000382:microbiology*; D010523:Peripheral Nervous System Diseases / Q000382:microbiology*