HIV distal sensory polyneuropathy (DSP) is the commonest neurological complication of HIV in sub-Saharan Africa. Our data shows between 20.9 and 43.2% of Tanzanians with HIV have DSP depending on risk factor exposure with a similar prevalence reported in other studies. Advanced HIV and a low CD4 count are known risk factors as are nucleoside reverse transcriptase inhibitors (NRTIs) which are present in all anti-retroviral treatment (ART) regimes. HIV DSP is also clinically similar to DSPs caused by nutritional deficiencies, diabetes and alcohol. Accurate diagnosis of HIV DSP is thus problematic, particularly in resource-constrained settings with limited access to investigations. Whilst recent WHO recommendations suggest earlier ART initiation with omission of cheaper neurotoxic NRTIs from formularies, financial constraints often preclude their implementation. A lack of medical infrastructure, particularly at the primary level, makes screening for, monitoring and management of HIV DSP difficult. Existing treatments for HIV DSP neuropathic pain are ineffective and often expensive or unavailable. There is little public health planning relating to HIV DSP in sub Saharan Africa and few data on the scale of disability it causes or its socioeconomic cost. We present a review of recent data relating to HIV DSP in sub Saharan Africa, highlight the challenges this epidemic presents and propose a protocol to screen for and manage HIV DSP in a resource-constrained outpatient setting.
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