Peripheral neuropathy in HIV patients: treatment by decompression of peripheral nerves.

Peripheral neuropathy is the most common nerve disorder in human immunodeficiency virus (HIV) patients. Distal symmetrical sensory polyneuropathy (DSP) affects roughly one third of HIV patients. With the introduction of antiretrovirals, more patients are surviving longer, and chronic complications are surfacing. Three consecutive patients with at least a 5-year history of HIV presented during the period from 2007 to 2009. All three patients were on antiretrovirals and had no other comorbid conditions such as spinal pathology or diabetes. All patients had symptoms of pain, numbness, and weakness. Quantitative sensory testing and/or electromyography/nerve conduction testing (EMG/NCT) were performed preoperatively and correlated with the presence of Tinel signs. Targeted nerve releases were performed in four extremities, for a total of 18 nerves. All three patients had symptomatic improvement at 1 year with a visual analog scale (VAS) reduction in pain by at least five points. Quantitative sensory testing showed improvement, as did two EMG/NCTs obtained postoperatively. This showed improvement in conduction velocity at the fibular tunnel and posterior tibial nerve at the tarsal tunnel. This is the first report of nerve decompressions in the lower and upper extremity of HIV patients in the literature outside of the median nerve in the carpal tunnel.