Minimising Peripheral Neuropathy in Patients Treated With HAART

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Assess Options if Neuropathy Occurs

Any patient who reports neuropathic symptoms which have persisted for more than 48 hours should be carefully monitored.[2]

For those who develop peripheral neuropathy, adequate treatment of any associated pain is important. Nonsteroidal anti-inflammatory drugs and simple analgesics may be sufficient.[2] For more severe, chronic pain tricyclic antidepressants, such as amitriptyline, may be helpful.[2] Anticonvulsants such as carbamazepine, valproic acid or possibly gabapentin, can be tried to alleviate severe lancinating pain.[2]

If treatment with nucleoside analogues is withdrawn, patients should be warned that a period of symptom intensification may occur after stopping treatment. This has especially been noted following the withdrawal of zalcitabine. Patients need to be reassured that although symptom intensification may last for several weeks to months, recovery of the sensory loss will usually occur.[2]

If a decision is made to discontinue the suspected nucleoside analogue, a careful assessment of the remaining treatment options needs to be made.Avoiding suboptimal antiviral cover needs to be taken into account as does the patient's history of past antiretroviral treatment and desire for further therapy.

Consideration should be given to the following options:[2]

  • stop all antiretroviral treatment

  • substitute with a nucleoside analogue which is not associated with peripheral neurotoxic effects (e.g. zidovudine, lamivudine, abacavir)

  • re-introduce treatment at half dose once symptoms have resolved to mild in severity.

If it is not appropriate to further treat the patient with nucleoside analogues, dual protease inhibitor combinations can be tried or treatment with a protease inhibitor plus a non-nucleoside reverse transcriptase inhibitor could be initiated.

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