How are HIV-associated multiple mononeuropathies treated?

Updated: Oct 23, 2019
  • Author: Emad R Noor, MBChB; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Intravenous immunoglobulin (IVIG) and plasmapheresis (plasma exchange) are preferred to immunosuppression. During a 7- to 10-day period, 4-5 plasmaphereses may be performed, as described in standard protocols. Potential complications include autonomic instability, hypercalcemia, and bleeding from depletion of clotting factors. The decision whether to use IVIG, plasmapheresis, or steroids should be based on the individual patient. [21, 22]

Treatment for mononeuropathies that are secondary to other co-existing conditions require focused therapy specific to that underlying organism or condition. For example, a more extensive disease state resulting from disseminated CMV infection can be treated with ganciclovir and/or foscarnet if instituted early. Conversely, the limited autoimmune form can be treated with IVIG, plasmapheresis, or steroids. These treatments have proven efficacious in some studies but not in others. 

Facial palsy recovery is similar to those without HIV and typically self-resolve. HAART has been shown to improve symptoms in patients with presumed HIV-induced optic neuropathy. [23]


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