A 44-year-old male presents with burning in both legs for the past 8 months which has become severe in the last 2 months. He has been diagnosed with HIV for the past 3 years. His current CD4+ cell count is 250 cells/ul and viral load 50 copies/ml. He was started on highly active antiretroviral therapy (HAART) about 3 months ago. He smokes marijuana and insists that it helps with his pain. 1. How prevalent is this disease presentation? Could you explain some of the epidemiologic features of this disease? Are there any cost concerns? In its 2012 HIV Surveillance Supplemental Report, the Centers for Disease Control estimates that over 1.1 million persons in the USA are infected with HIV, and predicts an additional 50 000 new infections each year.[1,2] The global prevalence of HIV is 33 million. These individuals are at risk for multiple neurologic complications due to their disease. The most common of these complications is distal symmetric polyneuropathy (DSP).[3,4] Its high prevalence ranks it as one of the more frequently encountered etiologies of neuropathic pain in the general population. As such, DSP is a substantial contributor to the healthcare cost of neuropathic pain as a whole. Berger et al examined this and demonstrated an average yearly healthcare cost of $17 355 for a patient with a painful neuropathic disorder versus $5715 for a matched control patient.
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