The Facts About Peripheral Neuropathy

Painful Condition Can Impact Mobility and Well-being of People Living With HIV

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What Is Peripheral Neuropathy?

Peripheral neuropathy (PN) is a condition caused by damage to the peripheral nerves. These peripheral nerves are those that exist outside of the brain and spinal chord which are responsible for delivering nerve impulses to the brain. These impulses are then translated into the physical sensations we feel on our hands, feet, and other parts of the body.


Sometimes PN is caused by the misfiring of impulses across the nerve endings.

At other times, there might be defect or deterioration of the myelin sheath (the insulating membrane covering the nerve). Such damage can affect the nerve's ability to send impulses from the feet and hands to the brain. As a result, numbness, tingling, and pain can develop, the severity of which can range from an irritating discomfort to pain so agonizing as to affect a person's mobility.

Some people with HIV-associated PN describe it as a burning sensation. Others say that it's like a thousand hot needles poking the feet and hands. Whatever you call it, it is a condition that can still plague many individuals with HIV and one for which there are few easy solutions.

What Causes Peripheral Neuropathy?

There are several causes of the nerve damage that can lead to peripheral neuropathy. Within the realm of HIV infection, we commonly associate PN with certain HIV-related and non-HIV-related conditions, including:

    Alcohol intake could also exacerbate or directly contribute to PN in people with HIV, as can high blood pressure, obesity, smoking, and vitamin B12 or E deficiency.

    What Medications Should I Be Concerned About?

    Some HIV medications can cause peripheral neuropathy, particularly earlier generation antiretroviral drugs which are less commonly used today. In addition, there are a few drugs used to treat HIV-associated conditions that can also cause PN-associated nerve damage. Among them:

    • Hivid (zalcitabine, ddC)
    • Videx and Videx EC (didanosine, ddI)
    • Zerit (stavudine, d4t)
    • Dapsone (used to decrease the risk of pneumocystis pneumonia)
    • Isoniazid (used to treat tuberculosis)
    • Myambutol (used to treat MAC and other bacterial infections)
    • Flagyl (a commonly prescribed antibiotic)

    If acted upon quickly, stopping the medication in question will usually resolve the PN. On occasion, lingering symptoms can persist for months or even years after treatment is stopped.

    How Is Peripheral Neuropathy Treated?

    PN can be treated with and without medicines, depending on the severity and the cause.

    For mild cases of PN, the replacement of the suspect drug is most often recommended. To better control pain, persons with PN can opt to take over-the-counter acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen.

    Other have turned to high-concentration 8% capsicum-based patches (Qutenza) as an alternative, which some studies have shown to alleviate PN-associated pain of the feet and legs for up to 12 weeks in some cases.

    In more serious cases, prescription medication may be prescribed. Among them:

    • Neurontin (an anti-convulsant)
    • Amitriptyline or nortriptyline (anti-depressants that increase peripheral nerve impulses)
    • COX-2 inhibitors (non-steroidal anti-inflammatory pain relievers)
    • Tramadol (an opioid pain reliever)
    • Corticosteroid injections

    Success rates vary from person to person, with some treatments working better than others.

    Furthermore, treating PN may require more than just medications and necessitates changes in lifestyle, including a reduction in smoking and alcohol intake.

    Regular moderate exercise is also considered important, contributing to improved circulation, mobility, and overall well-being. By contrast, inactivity (particularly sitting around in one place) can worsen the discomfort and anxiety associated with PN.


    U.S.Veteran's Administration. "Peripheral Neuropathy: Primary Care of Veterans with HIV." Washington, D.C.; issued April, 2009; updated October 28, 2011.

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