Justin McArthur, Johns Hopkins Univ. Sch. of Med., Baltimore, MD

In the 15 years since the first descriptions of a novel sensory neuropathy associated with AIDS, advances have been made in defining its epidemiology, clinical and neurophysiological features, and neuropathology. The risk factors and potential determinants for neuropathy have been examined through large ongoing cohorts of HIV-infected individuals. In addition to a sensory neuropathy associated with HIV infection, neuropathy as a toxic effect of dideoxynucleoside use is increasingly common. Biopsy and autopsy studies have defined the neuropathy as a "dying-back" axonopathy, with prominent macrophage infiltration, and a loss of distal nerve fiber terminals. Punch skin biopsy has been developed as a useful technique to demonstrate this loss of unmyelinated fibers. Nerve fiber regeneration is strikingly absent, and unregulated macrophage activation has been hypothesized as one of the critical mechanisms inducing axonal damage and degeneration. There are important parallels between the pathophysiological mechanisms in the peripheral and the central nervous system. Several clinical trials have now been completed, including a large Phase II trial of nerve growth factor which had positive effects both on neuropathic pain and the neurological examination.

Session 35. Symposium

HIV Virion Morphogenesis and Release

Tuesday, 2:00-4:00pm

Ballroom I-III