Neurological changes associated with HIV-DSP may begin early in the disease process yet remain at a
subclinical level for a long period of time, however, the symptoms often heighten and affect function as
the disease progresses.4,5 The HIV-DSP can cause impaired mobility, difficulty with self-care, and
uncontrolled pain.6 The pain, numbness, and paresthesia often experienced by patients with HIV-DSP
can have adverse effects on lower limb function, emotional state, sleep, and quality of life (QOL).6 Some
complain of a feeling of "walking on glass or sand" and many have difficulty bearing weight or wearing
shoes.7 Social inclusion and day-to-day activities are often affected by fluctuating symptoms and
impairments caused by HIV-DSP.5 Research has shown a statistically significant correlation between
neuropathic pain and limitations in daily activity function, unemployment, and reduced QOL as assessed
by the Medical Outcomes Study HIV Health Survey (MOS-HIV).' Adults with HIV-DSP self-report lower
physical quality of life and poorer leg function than HIV + adults without DSP.8 Recent work by Richert et
al suggests that neurologic complications of HIV disease contribute to a decline in locomotor function of
HIV infected individuals over time.9