LETTER
Neurologic Manifestations of HIV Infection
Raphael B. Stricker
1 June 1995 | Volume 122 Issue 11 | Pages 883-884
TO THE EDITOR:
Simpson and Tagliati [1] have provided an excellent and thorough review of the neurologic manifestations of HIV infection. The review fails, however, to mention one treatable cause of HIV-related peripheral neuropathy: cryoglobulinemia.
Type III (polyclonal) cryoglobulinemia has been associated with polyneuropathy and mononeuritis multiplex in two patients with HIV disease [2-4]. Neither patient was infected with hepatitis C virus [3, 4], and HIV was the only identifiable etiologic agent in each case. The neuropathy appeared to improve with plasmapheresis or zidovudine therapy [2, 4], although spontaneous neurologic improvement could not be excluded.
The true incidence of cryoglobulinemic neuropathy in HIV disease remains unknown. Because testing for cryoglobulins is not routinely done in HIV-infected patients, the role of cryoglobulinemia in HIV-related peripheral neuropathy may be greater than is suspected.
1. Simpson DM, Tagliati M. Neurologic manifestations of HIV infection. Ann Intern Med. 1994; 121:769-85.
2. Stricker RB, Sanders KA, Owen WF, Kiprov DD, Miller RG. Mononeuritis multiplex associated with cryoglobulinemia in HIV infection. Neurology. 1992; 42:2103-5.
3. Stricker RB, Kiprov DD. Mononeuritis and cryoglobulins. Neurology. 1993; 43:2159.
4. Le Lostec Z, Fegueux S, Vitale C, Geoffroy O, Bleton F, Mornet P. Peripheral neuropathy associated with cryoglobulinemia but not related to hepatitis C virus in an HIV-infected patient. AIDS. 1994; 8:1351-2.
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