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“The global HIV/AIDS epidemic is an unprecedented crisis that requires an unprecedented response. In particular it requires solidarity—between the healthy and the sick, between rich and poor, and above all, between richer and poorer nations. We have 30 million orphans already. How many more do we have to get, to wake up?”

Kofi Anon (1938–), Ghanian Diplomat and Former Secretary General of the United Nations

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Objectives

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On completion of this chapter, the student/practitioner will be able to:

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  • Discuss the role of antiretroviral medication in the treatment of HIV/AIDS.

  • List the various neuropathies associated with HIV/AIDS.

  • Describe the signs and symptoms of distal symmetrical polyneuropathy associated with HIV/AIDS.

  • List the risk factors associated with the development of distal symmetrical polyneuropathy in individuals with HIV/AIDS.

  • Discuss the role of complementary and alternative medicines used to treat HIV/AIDS–related polyneuropathy.

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Key Terms

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  • Antiretroviral medications

  • Distal symmetrical polyneuropathy

  • Highly active antiretroviral therapy

  • Human immunodeficiency virus (HIV)

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Introduction

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Following acute infection with human immunodeficiency virus (HIV), people who are untreated gradually progress from a period of being asymptomatic to having advanced HIV disease, or acquired immunodeficiency syndrome (AIDS). This progression may take several months or years. If left untreated, HIV/AIDS eventually leads to death. HIV/AIDS causes catastrophic levels of immunosuppression, increasing the risk of acquiring life-threatening opportunistic infections. Such infections are the leading cause of death in untreated HIV/AIDS. As a result of advances in medications used to treat this disease, people with HIV disease are living longer and leading more active lives. Successful treatment with antiretroviral drugs allows many people to live out their natural life span, but many of the drugs have adverse side effects. As people live longer with the disease, comorbidities may develop that complicate medical management and adversely affect quality of life. Common conditions, injuries, or other problems related to aging might affect long-term survival, especially in cases of advanced disease. Finally, a diagnosis of HIV disease may complicate medical management of preexisting health conditions.

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Antiretroviral medications to treat HIV disease have been available since the 1980s. The first antiretroviral drug, AZT (zidovudine), came into widespread use in the United States in 1986. Adverse side effects and toxicities associated with AZT as a monotherapy soon emerged. Later, “cocktails” of at least three different antiretrovirals from at least two different drug classes became the standard of care. Treatment of HIV disease with multiple antiretrovirals is known as highly active antiretroviral therapy (HAART). Because of HAART, HIV disease is now a chronic and generally manageable disease, assuming that patients have access to and are adherent to HAART. Although HIV/AIDS is not curable at the present time, pharmaceutical agents for the successful management of this disease continue to evolve and improve.

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Overview of HIV/AIDS–Associated Neuropathies

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As with other chronic diseases, complications and comorbidities may emerge over ...

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