title: Polyneuropathy induced by HIV disease and antiretroviral therapy.
abstract: OBJECTIVE
  To investigate the underlying mechanisms of polyneuropathy induced by HIV infection or antiretroviral drugs.
  
  
  METHODS
  We tested 100 HIV patients (59 with AIDS). Ninety-three patients received antiretroviral drugs. Forty-four were treated with neurotoxic compounds (ddI, ddC, d4T). Nerve conduction velocities and the sympathetic skin response (SSR) in palms and soles were measured in all patients. In skin biopsies (ankle and thigh), the intraepidermal nerve fiber density (IENFD) and the number of epidermal fibers without contact to the basal membrane (fragments) were quantified using PGP9.5 staining.
  
  
  RESULTS
  Severity of the disease (CD4 +count) correlated to conduction velocities of peroneal (p < 0.01, Spearmans rank correlation), sural (p < 0.01) and median nerves (p < 0.05/p < 0.001, sensory/motor). In contrast, the duration of neurotoxic treatment did not impair conduction velocities (p > 0.3) but correlated to reduced IENFD in the ankle (r = -0.24, p < 0.05). Despite their reduced IENFD, patients with long neurotoxic treatment had a high number of fragments irrespective of their CD4 +count.
  
  
  CONCLUSIONS
  Neurotoxic treatment appears to primarily impair thin fiber conduction, whereas HIV neuropathy is linked to large fiber impairment and reduction of fragments of nerve fibers.
  
  
  CONCLUSIONS
  These findings emphasize the differential pattern of polyneuropathy in HIV patients caused by the infection or induced by antiretroviral treatment.
authors: Department of Neurology, Aeginition Hospital, Medical School of Athens, Athens, Greece. pkokotis@med.uoa.gr
authors: Panagiotis
authors: P
authors: Kokotis
authors: Martin
authors: M
authors: Schmelz
authors: Georgios K
authors: GK
authors: Papadimas
authors: Elias E
authors: EE
authors: Skopelitis
authors: Kyriaki
authors: K
authors: Aroni
authors: Theodore
authors: T
authors: Kordossis
authors: Nikolaos
authors: N
authors: Karandreas
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000842:Ankle / Q000294:innervation; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001706:Biopsy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006679:HIV Seropositivity / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers; D036421:Nerve Fibers, Unmyelinated; D009431:Neural Conduction; D011115:Polyneuropathies / Q000139:chemically induced* / Q000209:etiology* / Q000503:physiopathology; D012867:Skin / Q000294:innervation; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013848:Thigh / Q000294:innervation; D055815:Young Adult