Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials

PLoS One. 2010 Dec 28;5(12):e14433. doi: 10.1371/journal.pone.0014433.


Background: Significant pain from HIV-associated sensory neuropathy (HIV-SN) affects ∼40% of HIV infected individuals treated with antiretroviral therapy (ART). The prevalence of HIV-SN has increased despite the more widespread use of ART. With the global HIV prevalence estimated at 33 million, and with infected individuals gaining increased access to ART, painful HIV-SN represents a large and expanding world health problem. There is an urgent need to develop effective pain management strategies for this condition.

Objective: To evaluate the clinical effectiveness of analgesics in treating painful HIV-SN.

Design: Systematic review and meta-analysis.

Data sources: Medline, Cochrane central register of controlled trials,, and the reference lists of retrieved articles.

Selection criteria: Prospective, double-blinded, randomised controlled trials (RCTs) investigating the pharmacological treatment of painful HIV-SN with sufficient quality assessed using a modified Jadad scoring method.

Review methods: Four authors assessed the eligibility of articles for inclusion. Agreement of inclusion was reached by consensus and arbitration. Two authors conducted data extraction and analysis. Dichotomous outcome measures (≥ 30% and ≥ 50% pain reduction) were sought from RCTs reporting interventions with statistically significant efficacies greater than placebo. These data were used to calculate RR and NNT values.

Results: Of 44 studies identified, 19 were RCTs. Of these, 14 fulfilled the inclusion criteria. Interventions demonstrating greater efficacy than placebo were smoked cannabis NNT 3.38 95%CI(1.38 to 4.10), topical capsaicin 8%, and recombinant human nerve growth factor (rhNGF). No superiority over placebo was reported in RCTs that examined amitriptyline (100mg/day), gabapentin (2.4 g/day), pregabalin (1200 mg/day), prosaptide (16 mg/day), peptide-T (6 mg/day), acetyl-L-carnitine (1g/day), mexilitine (600 mg/day), lamotrigine (600 mg/day) and topical capsaicin (0.075% q.d.s.).

Conclusions: Evidence of efficacy exists only for capsaicin 8%, smoked cannabis and rhNGF. However,rhNGF is clinically unavailable and smoked cannabis cannot be recommended as routine therapy. Evaluation of novel management strategies for painful HIV-SN is urgently needed.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Analgesics / therapeutic use*
  • Anti-Retroviral Agents / pharmacology
  • Cannabis
  • Capsaicin / therapeutic use
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Nerve Growth Factor / therapeutic use
  • Peripheral Nervous System Diseases / complications
  • Peripheral Nervous System Diseases / drug therapy*
  • Peripheral Nervous System Diseases / etiology*
  • Placebos
  • Plant Extracts / therapeutic use
  • Randomized Controlled Trials as Topic
  • Research Design
  • Risk
  • Treatment Outcome


  • Analgesics
  • Anti-Retroviral Agents
  • Placebos
  • Plant Extracts
  • Nerve Growth Factor
  • Capsaicin