Human Immunodeficiency Virus–Associated Distal Sensory Polyneuropathy: Still Common After Many Successes

Peripheral neuropathies have been associated with human immunodeficiency virus (HIV) infection since the earliest descriptions of its neurological manifestations. Among several distinct entities (eg, distal sensory polyneuropathy [DSPN], diffuse infiltrative lymphocytosis syndrome, and inflammatory demyelinating polyneuropathy), DSPN is not only the most common but arguably the most difficult to manage because of its chronic course and its painful symptoms. Typically, patients with DSPN report painful distal dysesthesias, burning, pins-and-needles sensations, numbness, and allodynia (painful response to an innocuous stimulus).¹ These symptoms begin in the feet, often on the soles, and, in the more symptomatic cases, progress up the legs.