What are HIV-associated multiple mononeuropathies?

Updated: Oct 23, 2019
  • Author: Emad R Noor, MBChB; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Multiple peripheral mononeuropathies can occur in the setting of HIV-1 disease. The presentation can be similar to multiple mononeuropathies in the non-HIV population. Early multiple mononeuropathy is usually self-limited and can present at the time of seroconversion. [2] Late multiple mononeuropathy in a patient with a CD4 count less than 50 cells/mm3 is usually related to cytomegalovirus (CMV) infection and can progress rapidly. [2, 3, 4, 5, 6, 7, 8, 9, 10]

A limited form of multiple mononeuropathy (1-2 nerves) presents in HIV-seropositive patients without AIDS and may have an autoimmune origin. A more generalized form (>2 nerves) presents in patients with AIDS. While CMV is often shown to be the cause, the occurrence of clinical CMV in AIDS has declined with the advent of highly active antiretroviral therapy (HAART).

The most common cranial mononeuropathy in HIV patients involves the facial nerve usually occurring around the time of seroconversion. Conditions known to accompany HIV such as CNS (central nervous system) lymphoma, diffuse infiltrative lymphocytosis syndrome, tuberculosis meningitis, syphilis, HSV-1, VZV, and vasculitis can also cause various cranial mononeuropathies.

Herpes zoster can occur in HIV patients in the form of trigeminal neuropathy. This is classically asociated with zoster vesicles with dermatomal distribution. Various cranial neuropathies involving the trochlear nerve, facial nerve, and mental branch of the trigeminal nerve can be associated with CNS lymphomas. [11, 12, 13] Diffuse infiltrative lymphocytosis syndrome can cause facial palsy. [14, 11]  Optic neuropathy has been reported in syphilis. [15]  Entrapment neuropathies can occur in advanced HIV disease.

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