Peripheral neuropathy in HIV: prevalence and risk factors.

TitlePeripheral neuropathy in HIV: prevalence and risk factors.
Publication TypeJournal Article
Year of Publication2011
AuthorsEvans SR, Ellis RJ, Chen H, Yeh T-min, Lee AJ, Schifitto G, Wu K, Bosch RJ, McArthur JC, Simpson DM, Clifford DB
JournalAIDS
Volume25
Issue7
Pagination919-28
Date Published2011 Apr 24
ISSN1473-5571
KeywordsAdolescent, Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Child, Female, HIV Infections, HIV-1, Humans, Longitudinal Studies, Male, Middle Aged, Peripheral Nervous System Diseases, Prevalence, Risk Factors, RNA, Viral, Young Adult
Abstract

OBJECTIVES: To estimate neuropathic sign/symptom rates with initiation of combination antiretroviral therapy (cART) in HIV-infected ART-naive patients, and to investigate risk factors for: peripheral neuropathy and symptomatic peripheral neuropathy (SPN), recovery from peripheral neuropathy/SPN after neurotoxic ART (nART) discontinuation, and the absence of peripheral neuropathy/SPN while on nART.

DESIGN: AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trial participants who initiated cART in randomized trials for ART-naive patients were annually screened for symptoms/signs of peripheral neuropathy. ART use and disease characteristics were collected longitudinally.

METHODS: Peripheral neuropathy was defined as at least mild loss of vibration sensation in both great toes or absent/hypoactive ankle reflexes bilaterally. SPN was defined as peripheral neuropathy and bilateral symptoms. Generalized estimating equation logistic regression was used to estimate associations.

RESULTS: Two thousand, one hundred and forty-one participants were followed from January 2000 to June 2007. Rates of peripheral neuropathy/SPN at 3 years were 32.1/8.6% despite 87.1% with HIV-1RNA 400 copies/ml or less and 70.3% with CD4 greater than 350 cells/μl. Associations with higher odds of peripheral neuropathy included older patient age and current nART use. Associations with higher odds of SPN included older patient age, nART use, and history of diabetes mellitus. Associations with lower odds of recovery after nART discontinuation included older patient age. Associations with higher odds of peripheral neuropathy while on nART included older patient age and current protease inhibitor use. Associations with higher odds of SPN while on nART included older patient age, history of diabetes, taller height, and protease inhibitor use.

CONCLUSION: Signs of peripheral neuropathy remain despite virologic/immunologic control but frequently occurs without symptoms. Aging is a risk factor for peripheral neuropathy/SPN.

DOI10.1097/QAD.0b013e328345889d
Alternate JournalAIDS
PubMed ID21330902
PubMed Central IDPMC3196556
Grant List1 U01 068634 / / PHS HHS / United States
AI068636 / AI / NIAID NIH HHS / United States
NS32228 / NS / NINDS NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI068636-04 / AI / NIAID NIH HHS / United States
U01 NS032228 / NS / NINDS NIH HHS / United States
U01 NS032228-12 / NS / NINDS NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI068634-07 / AI / NIAID NIH HHS / United States