In late HIV disease (CD4 count below 50 cells/mm3), patients may develop extensive mononeuritis with rapid progression49 and, without treatment, may die within 3 months.50 EMG shows multiple axonal mononeuropathies beginning distally and spreading proximally. Biopsy may show necrotizing vasculitis, cryglobulinemia, axonal and demyelinating lesions, and CMV inclusions.51 Gancyclovir may stabilize50 or reverse49 the deficits in CMV-induced mononeuro-pathy multiplex, and plasmapheresis provided improvement in one patient with HIV and cryo-globulinemia.52
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