PATHOPHYSIOLOGY
DSP neuropathy may be associated with the HIV infection itself or with antiretroviral toxicity. The condition is believed to be linked to axonal injury resulting from the binding of the viral envelope glycoprotein 120 to chemokine receptors and to macrophage dysregulation, which prompts the local release of proinflammatory neurotoxic cytokines.9, 10 The drug-associated neuropathies may be mediated by disrupted DNA synthesis, which interferes with mitochondrial function.11 With antiretroviral toxicity, symptom onset tends to be sudden and associated with the start of antiretroviral therapy (ART), usually peaking within the first three months of treatment