Painful Feet in HIV

I remembered a fellow poz who have been complaining about painful feet months ago. Another poz had his operation recently and was told that TB maybe the cause of his painful feet. We are still crossing our fingers that it is not. However, TB is an opportunistic infection and can affect any part of the body of an immunocompromised individual not only the lungs. Early detection and treatment is still the key. 

Because of this, I researched about painful feet and how it is related to TB and HIV.

What does it feel like?

Peripheral neuropathy is a long lasting pain that usually occurs in the lower legs. Often it is a burning sensation of the foot soles, sometimes so painful that you cannot walk or even put a blanket over your feet. Your feet may feel cold or numb or you may get a feeling of  pins and needles inside the feet. Sometimes peripheral neuropathy can also cause a tingling sensation in the fingers or around the mouth.

Who gets it?

People who suffer from poor nutrition, lack of vitamins or who take too  much alcohol may cause peripheral neuropathy. It is also associated with TB, sugar diabetes and HIV.  Peripheral neuropathy can also occur as a side effect of the TB medication INH or the HIV medications ddI and d4T.  Peripheral neuropathy does not only occur in people living with HIV, although they have a much higher chance of developing it.  It has not been noted in children with HIV.

What is it medically speaking?

Peripheral neuropathy is a lack of functioning of your nerves. Thousands of nerves pick up sensations all over your skin. The nerves run through the spinal cord to your brain where their messages get interpreted. In peripheral neuropathy the nerves send wrong messages to the brain and block others. The sensation of a blanket on your skin is registered as pain instead of touch.  Or your brain gets an exaggerated message that your legs feel cold and numb, which makes you put them close to a heater. The nerves block the message that your skin is heating up and you do not feel the pain of burning blisters on your legs.

Making the diagnosis of peripheral neuropathy

Your nurse or doctor will be able to make the diagnosis when you tell them your symptoms. The doctor can then test your ability to register pain, temperature and vibrations.

Staging of HIV

Peripheral neuropathy can occur at any stage of HIV disease and at any CD4 count. However, it is more common and often more severe in more progressed HIV illness. Peripheral neuropathy is not used for the classification of stages of HIV.

Treatment for peripheral neuropathy

Often you will already feel better once the cause of these pains have been explained to you.

a. If you get peripheral neuropathy while on TB treatment, add Pyridoxine tablets. They counter this side effect of INH.

b. If you are already using Pyridoxine and still have symptoms, treat it like all other peripheral neuropathy with Amitryptyline.

c. Amitryptyline was developed as medicine against depression, but at lower doses (1-2 tablets) it can relieve the pain of peripheral neuropathy. It makes you sleepy so you should take it at night. This helps many people who could not sleep well before.

d. At the moment most nurses are not allowed to prescribe Amitriptyline. To treat people living with HIV more effectively it might be necessary to change this restriction.

Other medicines

Some doctors give Carbamazepine (an epilepsy medication) for peripheral neuropathy. It works, but makes antiretrovirals (ARVs) ineffective.  People living with HIV should therefore stay away from Carbamazepine. If the pain is not relieved by Amitriptyline try adding pain tablets like Ibuprofen, Indomethacin or even Codeine and Morphine. Vitamin B Co and Folic acid have not been studied scientifically for treatment of peripheral neuropathy, but some people believe they help. It is also advisable to stop drinking alcohol.

If you suspect that the peripheral neuropathy is caused by some of your TB or HIV medications, discuss this with your doctor and do not simply stop these medications on your own.