How is progressive polyradiculopathy in HIV infection treated?

Updated: Nov 05, 2019
  • Author: Emad R Noor, MBChB; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

Treatment strategies depend on the etiology. In idiopathic polyradiculopathy, spontaneous improvement without treatment is common. [10]

For CMV, prompt initiation of therapy is critical. Combination treatment with ganciclovir and foscarnet may be preferred as initial therapy to stabilize disease and maximize response, although it has substantial rates of adverse effects. [17] Ganciclovir-resistant CMV may respond to foscarnet, but mortality remains high. CMV polyradiculopathy can be fatal within 2 months making early treatment extremely important. 

CMV polyradiculopathy responds to cidofovir in combination with highly active antiretroviral therapy (HAART). [18] Acyclovir inhibits activity of both HSV-1 and HSV-2.

In cases of subacute lumbosacral radiculopathy in immunocompetent individuals, symptoms can resolve spontaneously over weeks. Others have responded to corticosteroids. [25]

Symptomatic treatment for neuropathic pain include agents such as gabapentin, pregabalin, nortriptyline, amitriptyline, lamotrigine, venlafaxine, and duloxetine. Physical therapy is also recommended.


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