NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR INDUCED PERIPHERAL

NEUROPATHY IN A CHILD WITH HIV INFECTION

Susanti Rahmayani, Prastiya Indra Gunawan, Riza Noviandi, Sunny Mariana Samosir

Department of Child Health, Faculty of Medicine, Universitas Airlangga/

Dr.Soetomo Academic General Hospital, Surabaya, Indonesia

OBJECTIVE: The pathophysiology of peripheral neuropathy due to Nucleoside Reverse

Transcriptase Inhibitor (NRTIs) agents causing peripheral nerve damage are vary like
microtubular damage, mitochondrial dysfunction, and neuronal apoptosis. The aim of this study
highlight the importance of early detection and how to solve the side effect of NRTIs, focus on
peripheral neuropathy.

CASE REPORT: We report a 13 years old girl with chief complaint right hand twitching, severe
since three days before she went to neuropediatric outpatient clinic. She’s been taking NRTIs
for 12 years. Neurologic examination showed no weakness and atrophy in the upper right limb.
No atrophy in her right and left hands. Rigid was present at moment when fasciculations
happened. She was given trihexyphenidyl 2 mg every 12 hours and fasciculations significantly
decreased in three weeks.

CONCLUSION: Patient-associated risk factors for peripheral neuropathy include diabetes

mellitus type 1, hyperthyroidism, nutritional deficiencies, drug induced peripheral neuropathy
(DIPN), in this case was NRTIs. The diagnosis of NRTIs induced peripheral neuropathy requires
clinical assessment from history taking, judicious laboratory which was normal in this patient,
electrodiagnostic studies or nerve biopsy if the diagnosis remains unclear. Treatment of
peripheral neuropathy has two goals, controlling the underlying disease process and treating
troublesome symptoms. NRTIs to this patient cannot be eliminated. She had been given
trihexyphenidyl 2 mg every 12 hours and showed fasciculations significantly decreased.
Trihexyphenidyl showed a stimulating effect of dopamine, through the blockade of muscarinic
receptors on the parasympathetic nervous system. This patient has good prognose, no
complications were found during and after trihexyphenidyl was given.

Keywords: NRTIs, Peripheral Neuropathy, HIV Infection, Trihexyphenidyl.