8% capsaicin patches for HIV-induced polyneuropathy: a systematic review and meta-analysis

Human immunodeficiency virus is a harrowing illness that causes significant sequelae besides immune suppression. One of the long-term effects of both virus and antiviral medication is distal sensory polyneuropathy. Treating this HIV-induced neuropathy is a difficult challenge for clinicians, with standard of care medications having significant side effects. Recently, 8% topical capsaicin patches have been shown to help with various other forms of neuropathy, but no systematic review has investigated the potential benefit of HIV-induced neuropathy.

A thorough systematic review of five databases (PubMed, Embase, Scopus, Web of Science, Cochrane) was conducted in October 2025. Retrieved articles were screened for the primary outcome of pain scores both before and after application of the topical capsaicin patch. Statistical analysis was stepwise, with an initial heterogeneity test (Higgins I²), followed by a random-effects meta-analytics based on the moderately high degree of heterogeneity.

Our investigation found a total of seven articles that fit our inclusion and exclusion criteria. The overall effect size for the most common patch-application duration was d = 0.991 (95%CI: 0.619-1.36) for improvement in pain score. To control for our high heterogeneity, a leave-out analysis was conducted on the studies with highest risk of bias, with repeat meta-analytics denoting a d = 0.96.

Our systematic review and meta-analysis notes that topical 8% capsaicin patches are effective in reducing neuropathic pain in patients with HIV-neuropathy. Future larger studies should be conducted to investigate the place of 8% capsaicin patches in the treatment algorithm for HIV-neuropathy.

www.crd.york.ac.uk/prospero identifier CRD420251114796.