References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Peripheral neuropathy — tingling, numbness, burning or pain in the hands and feet — is one of the most common neurological complications of HIV. It can be caused by the virus itself, by older antiretroviral drugs, or by other conditions. Modern treatment has made severe neuropathy less common, but milder symptoms still affect many people.
Here’s what causes it and how to manage it.
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What Is Peripheral Neuropathy?
Peripheral neuropathy happens when nerves outside the brain and spinal cord are damaged. In HIV, the nerves in the feet are usually affected first, followed by the hands — a pattern called “stocking-glove” distribution.
Symptoms
- Tingling or “pins and needles” in feet or hands
- Numbness or reduced sensation
- Burning or shooting pain
- Sensitivity to touch (even bedsheets can be painful)
- Difficulty walking or balance problems
- Weakness in the feet or hands (less common)
Causes
| Cause | Detail |
|---|---|
| HIV itself | Direct nerve damage from the virus, especially with low CD4 counts |
| Older ART drugs | Stavudine (d4T), didanosine (ddI), zalcitabine (ddC) — rarely used now |
| B12 deficiency | More common with HIV; easily treated |
| Diabetes | More common in people with HIV |
| Alcohol | Chronic heavy drinking damages nerves |
| Other medications | Isoniazid (for TB), some chemotherapy drugs |
Treatment
Address the cause
- Start or optimise ART — reducing viral load helps
- Switch away from neurotoxic drugs if still on them
- Treat B12 deficiency
- Manage diabetes
- Reduce alcohol
Pain management
- Amitriptyline — low-dose tricyclic antidepressant, often first-line
- Gabapentin or pregabalin — effective for nerve pain
- Duloxetine — SNRI antidepressant with pain-relieving properties
- Capsaicin cream — topical option for localised pain
- Paracetamol — mild cases
Opioids are generally avoided for chronic neuropathic pain because of addiction risk and limited effectiveness.
Self-care
- Wear comfortable, well-fitting shoes
- Check feet daily for injuries you might not feel
- Keep feet moisturised
- Gentle exercise improves circulation and can reduce symptoms
- Avoid tight socks or restrictive footwear
Read more: Side effects of treatment | Pain and HIV | What is HIV?
Frequently Asked Questions
Will neuropathy get better?
If the cause is addressed (e.g. switching drugs, treating B12 deficiency), symptoms often improve but may not resolve completely. Early treatment gives the best outcomes.
Is neuropathy caused by modern HIV drugs?
Modern ART rarely causes neuropathy. The drugs responsible (stavudine, didanosine) are almost never used in the UK today.
Can I exercise with neuropathy?
Yes — gentle exercise like walking, swimming and cycling can actually help reduce symptoms and improve circulation. Avoid high-impact activities if balance is affected.
Related reading
- Abnormal Genital Discharge and Chlamydia
- Asymptomatic STIs: Silent Infections Explained
- Causes of Painful Sex and How to Treat It
- Cold Sores vs Syphilis Sores: How to Tell the Difference
- Common STI Symptoms in Women
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
