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Q J Med 1992; 83: 473-488
© 1992 Association of Physicians

research-article

A Study of Neuropathy in HIV Infection

JB WINER, B BANG, CLARKE, JR*, K KNOX, TJ COOK{ddagger}, M GOMPELS, RAC HUGHESx, SM HALL@, AJ PINCHING, JWR HARRIS§, V KITCHEN§, DJ JEFFRIES*, S LEIBOWITZ@, S SMITH#, Z COCKBAIN#, T EKONG and C HUGHES

Department of Neurology, St Marys Hospital London, W2 1NY *Department of Virology, Clinical Immunology, St Marys Hospital London, W2 1NY §Department of Genito-Urinary Medicine, St Marys Hospital London, W2 1NY {ddagger}Department of Pathology, St Marys Hospital London, W2 1NY #Department of Neurophysiology, St Marys Hospital London, W2 1NY Department of Clinical Chemistry, St Marys Hospital London, W2 1NY xDepartment of Neurology, United Medical and Dental Schools of Guy's and St Thomas's Hospitals Guy's Campus, London SE1 9RT @Department of Anatomy, United Medical and Dental Schools of Guy's and St Thomas's Hospitals Guy's Campus, London SE1 9RT

Address correspondence to Dr JB Winer, Department of Neurology, Queen Elizabeth Hospital, Edgbaston, Birmingham B 15 2TH.

Accepted for publication 17 February 1992.

A prospective study of possible aetiological factors for neuropathy associated with HIV infection was performed in 80 patients and 28 homosexual controls. At entry to the study twelve patients (15 per cent) had evidence of a generalized neuropathy not due to any other cause and a further three patients developed symptomatic neuropathy during a mean (SD) follow-up of 20 (7.5) months. All but two of these neuropathies were of the distal symmetrical sensory type. Electrophysiology was consistent with an axonal pathology and nerve biopsy confirmed this as the major pathological change. Warming threshold was the diagnostic test most frequently abnormal, sometimes in the absence of other electrophysiological abnormalities. No association was seen with opportunistic infection (cytomegalovirus, herpes simplex, Pneumocystis pneumonia, toxoplasmosis, Cryptococcus infection or tuberculosis). HIV proviral DNA could not be detected in paraffin sections of peripheral nerve in six patients with neuropathy. The presence of the neuropathy did not show significant correlation with depression of the number of CD4+T cells in the blood, impaired T cell function tests, or IgG, IgM, or IgA levels. Immune complexes containingC1q, but not those containing IgG, IgM, IgA or C3c, were significantly more common among neuropathic patients ({rho} =0.01).


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