HIV-Associated Sensory Neuropathy: Still a Problem in the Post-Stavudine Era?

Abstract

Sensory neuropathy (SN) is a common and difficult to manage cause of chronic pain in HIV. Recent recommendations for earlier HIV treatment and avoidance of neurotoxic antiretroviral drugs (such as stavudine) have led to optimism that HIV-SN rates may decline. We present several reasons as to why HIV-SN is likely to remain prevalent, despite improvements in HIV management, together with clinical evidence confirming high HIV-SN rates in cohorts never exposed to neurotoxic medications. A combination of epidemiologic studies, laboratory work and clinical trials are needed to understand the problem of HIV-SN in the post-stavudine era. Improved HIV-SN prevention and management strategies are needed if the morbidity associated with HIV infection is to improve along with life expectancy.

Keywords:

• HIV
• neuropathogenesis
• pain
• sensory neuropathy
• stavudine

Financial & competing interests disclosure

CL Cherry is supported by funding from Australia‘s National Health and Medical Research Council and gratefully acknowledges the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute. She has previously received support for HIV-SN-related research from CNS Bio Australia, Zymes LLC and Roche Australia. PR Kamerman has received honoraria from Pfizer for educational presentations related to HIV-SN. DLH Bennett is supported by funding from the Wellcome Trust (London Pain Consortium). ASC Rice is supported by funding from the Derek Butler Trust, Wellcome Trust (London Pain Consortium) and the European Commission (Innovative Medicines Initiative Grant EUROPAIN). He has held consultancies through Imperial College Consultants for various companies developing drugs for neuropathic pain. In the last 12 months these have included Astella, Pfizer and Spinifex. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

CL Cherry is supported by funding from Australia‘s National Health and Medical Research Council and gratefully acknowledges the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute. She has previously received support for HIV-SN-related research from CNS Bio Australia, Zymes LLC and Roche Australia. PR Kamerman has received honoraria from Pfizer for educational presentations related to HIV-SN. DLH Bennett is supported by funding from the Wellcome Trust (London Pain Consortium). ASC Rice is supported by funding from the Derek Butler Trust, Wellcome Trust (London Pain Consortium) and the European Commission (Innovative Medicines Initiative Grant EUROPAIN). He has held consultancies through Imperial College Consultants for various companies developing drugs for neuropathic pain. In the last 12 months these have included Astella, Pfizer and Spinifex. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.