HIV-associated sensory neuropathy in HIV-1 infected patients at the Douala General Hospital in Cameroon: a cross-sectional study

Abstract

BackgroundPeripheral neuropathy (PN) which is the most common neurological complication of HIV infection is under recognised and undertreated especially in resource limited settings. This ailment which has a negative impact on the quality of life of HIV/AIDS patients exists in different clinical patterns of which HIV-associated Sensory neuropathy (HIV-SN) is the most common affecting up to two thirds of patients with advanced disease in some settings. In Cameroon where HIV is a major public health problem, the burden of HIV-SN has not yet been well defined.MethodsUsing the Brief Peripheral Neuropathy Screening (BPNS) tool validated by the AIDS Clinical Trial Group (ACTG) we carried out a cross sectional study to determine the prevalence of HIV-SN and its associated factors among HIV-1 patients at the Douala General Hospital between 1st July and 31st October 2011. HIV-SN was defined as the presence of neuropathic symptoms and at least an abnormal perception of vibrations of a 128Hz tuning fork on the great toe or abnormal ankle reflexes or both and expressed as a percentage of the study population.ResultsOut of 295 patients studied, 21% had HIV-SN. In HIV-SN patients the median duration of HIV infection was 79.8 months (IQR 46 – 107.5) and their median CD4 count 153cells/μL (IQR 80 – 280). Patient recall and clinical chart review showed that, 83.9% had neuropathic symptoms prior to HAART initiation and 16.1% after HAART initiation. Low CD4 count, history of alcohol intake and history of anti-tuberculosis treatment were strongly associated with HIV-SN (AOR 2.5, 2.8 and 2.9 respectively).ConclusionsHIV-SN is common among patients with advanced HIV infection in Cameroon. This simple diagnostic tool (BPNS) should therefore be routinely used to detect those with HIV-SN or at risk so as to minimise the negative impact it has on their quality of life.

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

“…Post-ART prevalence in resource-limited settings from previous studies has been estimated between 20 and 50% [13][14][15] but with a wide variation noted in a previous systematic review [15]. Thirteen percent of the DART trial population reported preexisting peripheral neuropathy at ART initiation, which is lower than the post-ART peripheral neuropathy prevalence from previous studies, which however highlights the importance of nondrug-based factors.…”

“…However, these tools have been less frequently used in resource-limited settings. The few existing studies in sub-Saharan Africa have shown widely varying prevalence of 1-60% with HIV or ART-related peripheral neuropathy [7,[9][10][11][12][13][14][15]. The post-ART incidence rates for peripheral neuropathy were also not consistent across several studies, varying between 0.9 and 40 per 100 person-years in a review [15].…”

HIV neuropathy in pre-HAART patients and it′s correlation with risk factors in Central India

“…[13] We found that HIV-SN is more common among middle-age group patients, similar with findings in other studies. [20] These authors reported 21% prevalence of HIV neuropathy. [20] This suggests that some patients though asymptomatic, might have abnormal signs related to HIV-SN but do not meet the HIV-SN diagnostic criteria as per the BPNS tool.…”

“…[20] These authors reported 21% prevalence of HIV neuropathy. [20] This suggests that some patients though asymptomatic, might have abnormal signs related to HIV-SN but do not meet the HIV-SN diagnostic criteria as per the BPNS tool. Some authors considered this group as asymptomatic PN who perhaps represent those with early HIV-SN who are more likely to become symptomatic when challenged with HAART or other risks for PN.…”

HIV-related neuropathy: current perspectives

“…Most estimates of the prevalence of HIV DSP in the cART-era range from 50%–60%, although prevalence as low as 21% has been reported 2,6,7. This variability can be in part attributed to the different definitions of HIV DSP, with some studies defining DSP as one clinical sign (ie, reduced ankle reflexes or reduced pinprick sensation or reduced vibration sensation in the feet), some requiring two clinical signs, and some using validated screening or diagnostic instruments 7,43,49.…”