Table 1.

Agents Used in the Treatment of Peripheral Neuropathy in HIV-Infected Patients

Agent	Comments
Gabapentina	In a randomized controlled trial of gabapentin vs placebo in 26 HIV-infected patients, 44% of subjects reported improvement in neuropathic pain and 48% reported improvement in sleep in the gabapentin group, and no improvements were reported in the placebo group.44
Pregabalin	A randomized controlled trial of pregabalin vs placebo in 302 HIV-infected patients showed lack of superiority of pregabalin.45 However, based on its similarity to gabapentin, and its ease of administration and superior tolerability, it is often prescribed for the treatment of peripheral neuropathy.
Amitriptyline	Randomized trials of amitriptyline, mexiletine, or placebo46 and a 2 x 2 factorial design of amitriptyline and acupuncture47 found no difference between amitriptyline and placebo. However, due to its efficacy in other populations (eg, diabetic neuropathy), amitriptyline and other tricyclic antidepressants are often used to treat neuropathy in HIV-infected patients.
Capsaicina	Two similarly designed randomized controlled trials in which high-dose capsaicin (8%) was compared with a low-dose control (0.04%) demonstrated efficacy. Analysis of combined data from both trials showed an improvement of 27% with the high dose vs 16% with the low dose (n = 239 and n = 100, respectively).48
Lidocaine	A randomized, controlled, crossover study of topical lidocaine in 64 participants found it to be no more effective than placebo in HIV-infected patients with peripheral neuropathy.49
Opioids	There are no studies of opioids in HIV-infected patients with peripheral neuropathy. However, opioids are commonly used in the treatment of chronic nonmalignant pain and, in particular, have been shown to have at least some efficacy in the treatment of neuropathic pain in non–HIV-infected patients.50 They are sometimes used in the management of peripheral neuropathy in HIV-infected patients.

Based on the literature for diabetic neuropathy, duloxetine or valproic acid may be considered for second-line management of peripheral neuropathy in HIV-infected patients. aProven efficacy for HIV peripheral neuropathy in at least 1 randomized controlled trial. Compiled from Hahn et al,44 Simpson et al,45 Kieburtz et al,46 Shlay et al,47 Brown et al,48 Estanislao et al,49 and Eisenberg et al.50