Age and height predict neuropathy risk in patients with HIV prescribed stavudine

Cherry, Catherine L.; Affandi, Jacquita S.; Imran, Darma; Yunihastuti, Evy; Smyth, K; Vanar, Sasheela; Kamarulzaman, Adeeba; Price, Patricia

doi:10.1212/wnl.0b013e3181af7a22

Cited by 79 publications

(76 citation statements)

References 20 publications

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“…Previous studies have shown peripheral neuropathy associations with age consistently [35][36][37] and also with either weight or BMI; we observed higher peripheral neuropathy risk in heavier individuals comparable to previous studies [10,38]. Models including pre-ART BMI rather than weight gave similar inferences in our data (not shown).…”

Section: Aids 2014 Vol 28 No 17supporting

confidence: 89%

Prevalence, incidence and predictors of peripheral neuropathy in African adults with HIV infection within the DART trial

Kiwuwa-Muyingo

Kikaire²,

Mambule³

et al. 2014

Aids

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Objectives: We investigated the prevalence, incidence and predictors of new peripheral neuropathy episodes in previously untreated, symptomatic HIV-infected Ugandan/Zimbabwean adults initiating zidovudine-based antiretroviral therapy (ART).Design: An open-label, multicentre, randomized trial. Methods:Peripheral neuropathy was self-reported at 12-weekly clinic visits. Cox regression models (excluding participants reporting preexisting peripheral neuropathy at ART initiation), considered sex; pre-ART WHO stage, age and CD4 þ cell count; CD4 þ cell count versus no CD4 þ cell count monitoring; and time-updated CD4 þ cell count, weight and use of stavudine, isoniazid and didanosine.Results: Four hundred and twenty-one out of 3316(13%) patients reported preexisting peripheral neuropathy at ART initiation. Median (interquartile range, IQR) follow-up in 2895 participants without preexisting peripheral neuropathy was 4.9 (4.7-5.4) years. Three hundred and fifty-four (12%) took stavudine as first-line substitution and 518 (18%) took isoniazid during follow-up. Two hundred and ninety (11%) participants developed a new peripheral neuropathy episode, an incidence of 2.12 per 100 personyears. Eighteen (0.1%) had a grade 3/4 episode. Independent predictors of peripheral neuropathy were current stavudine use [adjusted hazard ratio (a)HR 4.16 (95% confidence interval, 95% CI 3.06-5.66], current isoniazid use [aHR 1.59 (95% CI 1.02-2.47)] and current didanosine use [aHR 1.60 (95% CI 1.19-2.14)]. Higher risks were independently associated with higher pre-ART weight [aHR (perþ5 kg) 1.07 (95% CI 1.01-1.13)] and older age aHR (per 10 years older) 1.29 (95% CI 1.12-1.49), but there was no significant effect of sex (P ¼ 0.13), pre-ART CD4 þ cell count (P ¼ 0.91) or CD4 þ cell count monitoring (P ¼ 0.73).Conclusion: Current stavudine, didanosine or isoniazid use continue to increase peripheral neuropathy risks, as does older age and weight at ART initiation; however, we found no evidence of increased risk in women in contrast to previous studies. The incidence of peripheral neuropathy may now be lower in ART programmes, as stavudine and didanosine are no longer recommended. All patients receiving isoniazid, either as part of antituberculosis (TB) chemotherapy or TB-preventive therapy, should receive pyridoxine as recommended in national guidelines.

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Section: Aids 2014 Vol 28 No 17supporting

confidence: 89%

Prevalence, incidence and predictors of peripheral neuropathy in African adults with HIV infection within the DART trial

Kiwuwa-Muyingo

Kikaire²,

Mambule³

et al. 2014

Aids

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“…This association has been observed in cohort studies in resource-limited and resourcerich settings. 4,[13][14][15] The use of a validated screen in our study provides strength to this association previously found in the few studies conducted in patients in Africa. 4,14,15 We also found that current D4T use was protective against signs of neuropathy (vibratory sense and ankle reflexes).…”

Section: Discussionsupporting

confidence: 61%

“…4,[13][14][15] The use of a validated screen in our study provides strength to this association previously found in the few studies conducted in patients in Africa. 4,14,15 We also found that current D4T use was protective against signs of neuropathy (vibratory sense and ankle reflexes). Although this finding seems counterintuitive, this likely represents survivor bias, whereby patients receiving D4T in whom neuropathy did not develop continued receiving D4T-based regimens at the time of the study screen, and those receiving D4T in whom neuropathy developed before study entry were switched to a non-D4T-based regimen before screening.…”

Section: Discussionsupporting

confidence: 61%

Implementation of a Validated Peripheral Neuropathy Screening Tool in Patients Receiving Antiretroviral Therapy in Mombasa, Kenya

Mehta¹,

Ahmed²,

Kariuki³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract. Limited objective data are available for the prevalence of peripheral neuropathy (PN) among antiretroviral (ART)-treated human immunodeficiency virus (HIV)-infected patients in resource-limited settings. A validated neuropathy-screening tool was integrated into routine ART visits at an HIV clinic in Mombasa, Kenya. Diagnosis of PN required at least one symptom and either abnormal vibratory sensation or deep tendon reflex bilaterally. Among 102 consecutively screened patients, 63% were women, 62% were receiving ART for ≤ 1 year, and 86% were receiving a stavudine (D4T)-based regimen. Thirty-seven (36%) had PN. Univariate analysis showed that current D4T use was protective against PN ( P = 0.03) and older age was a marginal risk factor ( P = 0.05). Multivariate analysis showed that older age was a risk factor for neuropathy ( P = 0.04). Peripheral neuropathy was common, particularly among older HIV-infected adults in Kenya. The protective association with current D4T use likely represents survivor effect bias. Longitudinal studies using this screen will help further characterize PN in resource-limited settings.

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“…We have recently developed algorithms for the evaluation of neuropathy risk. 11,12 Here we systematically evaluate whether HCV seropositivity should be considered in this context. METHODS Cross-sectional data were analyzed from 7 studies of HIV-associated neuropathy performed at 6 sites in 5 countries.…”

mentioning

confidence: 99%

Hepatitis C seropositivity is not a risk factor for sensory neuropathy among patients with HIV

Cherry¹,

Affandi²,

Brew³

et al. 2010

Neurology

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Age and height predict neuropathy risk in patients with HIV prescribed stavudine

Abstract: Stavudine neuropathy risk increases with patient age and height. Prioritizing older and taller patients for alternative agents would be an inexpensive strategy to reduce neuropathy rates in countries where the burden of HIV disease limits treatment options.

Cited by 79 publications

References 20 publications

Prevalence, incidence and predictors of peripheral neuropathy in African adults with HIV infection within the DART trial

Prevalence, incidence and predictors of peripheral neuropathy in African adults with HIV infection within the DART trial

Implementation of a Validated Peripheral Neuropathy Screening Tool in Patients Receiving Antiretroviral Therapy in Mombasa, Kenya

Hepatitis C seropositivity is not a risk factor for sensory neuropathy among patients with HIV

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