Auricular Vagus Nerve Stimulation Mechanisms for HIV-Associated Peripheral Neuropathy

Inclusion Criteria:

* Established HIV infection
* Glove/stocking dysesthesias lasting for ≥3 months
* HIV-associated peripheral neuropathy (HIV-PN) related symptoms ≥4 (on a scale of 0-10) within the last week
* Stable medical care (i.e., no changes in Antiretroviral Therapy or pain medication within 2 months of enrollment)
* Able to read the consent form, demonstrate understanding of study procedures and requirements, and independently provide written informed consent

Exclusion Criteria:

* Unstable cardiac disease
* Implanted electronic or magnetic devices (e.g., pacemaker, cochlear implants, medication pumps, and other implanted neurostimulation systems)
* Head or neck cancer or metastases
* Recent ear trauma or metal implants in the head
* History of epilepsy, unprovoked seizure, stroke, brain tumor, significant traumatic brain injury, prior intracranial surgery, or other neurological condition associated with increased seizure risk
* Active or uncontrolled comorbidities that independently cause neuropathy (e.g., recent chemotherapy, uncontrolled diabetes with documented neuropathic complications)
* Clinical evidence of non-HIV neuropathy (e.g., neuropathic symptoms predating HIV diagnosis, uncontrolled diabetes)
* Known allergy to tape/adhesive
* Ferromagnetic or non-MRI-compatible metal in the head, neck, eye, or cranial region, including aneurysm clips, retained metal fragments, bullets, shrapnel, or other metallic implants not demonstrated to be TMS-compatible.
* Pregnancy or actively breast feeding