Cytomegalovirus and the peripheral nervous system in AIDS

Cytomegalovirus (CMV) has been associated with a spectrum of peripheral nerve syndromes in patients with AIDS. Lumbosacral polyradiculopathy, a rapidly progressive syndrome occurring in about 1% of AIDS patients, is characterized by low back pain, sphincter disturbance, progressive flaccid paraparesis, and neutrophil cerebrospinal fluid pleocytosis. CMV has been found consistently in the lumbosacral roots in association with inflammation, demyelination, and axonal loss. Anti-CMV therapy has been reported in open studies to prolong survival and may lead to improvement of the neurologic deficit. A few patients with mononeuritis multiplex have been found to have CMV inclusions associated with inflammation and axonal loss in the peripheral nerve. The diagnosis, dependent on finding CMV in a biopsy sample, has been made too infrequently to estimate the incidence and prognosis or response to treatment. Painful distal symmetrical peripheral neuropathy, the most frequent neuropathy in AIDS, is characterized by subacute onset of pain in the feet, with associated findings including mild sensory signs and fiber degeneration axonal atrophy on sural nerve biopsy. A prospective study found an association of this syndrome with CMV disease of other organs, and CMV has been found in the dorsal root ganglion in a single case. Anti-CMV therapy might be of benefit in these peripheral nerve syndromes; however, the effect of such treatment needs to be assessed in controlled studies.