Nerve conduction changes in asymptomatic HIV-1 seropositive individuals in the absence of other risk factors for neuropathy.

The major problem in determining the role of HIV-1 infection in the pathogenesis of peripheral neuropathy is the difficulty in separating possible effects of confounding factors such as other infections, malnutrition, neurotoxic medication, drug abuse and antiretroviral treatment. We therefore selected 28 neurologically asymptomatic HIV-seropositive homosexual men (category A, CDC 1993) without other recognized reasons for peripheral nerve disease and 20 age, sex and height matched healthy controls for a prospective nerve conduction study. Nine (32%) HIV-seropositive patients had single nerve conduction abnormalities and 2 (7%) had at least two abnormalities considered to be indicative of subclinical neuropathy. Even patients with normal CD4 cell counts showed significantly lower mean sural nerve conduction velocities and higher tibial distal motor latencies compared to controls (ANOVA; p < 0.05). There was an overall trend toward more frequent nerve conduction changes in subgroups with abnormal CD4 cell counts, lymphocyte responsiveness or beta 2-microglobulin levels. Using strict selection criteria subclinical nerve conduction changes can be found even in the absence of symptomatic HIV-disease or potential confounding factors suggesting that HIV-1 plays a direct role in the pathogenesis of associated peripheral nervous system disease.