HIV neuropathy in South Africans: Frequency, characteristics, and risk factors

Abstract

The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection.

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

“…1 However, World Health Organization guidelines and many national guidelines in resource-limited countries recommend D4T or zidovudine as first-line treatment with recent recommendations to reduce the dose of D4T to 30 mg to minimize adverse events. 2 Several studies from sub-Saharan Africa have also found PN to be a significant side effect in patients receiving D4T-based ART (range = 4.3-56%) [3][4][5][6][7][8]13 and the most common reason for switching regimens because of adverse events. 5 However, use of a validated screen for neuropathy was not reported in most of these studies.…”

Distal Sensory Polyneuropathy among HIV Patients in Libreville in Gabon

“…The frequency of DSP in our study was 27.4%. It was less than other reported in various countries in Africa [8]- [11] [16]. The difference could be explained by the sample size, the mean age of the populations, the proportion of population on HAART and the diagnosis tool used by authors.…”

“…Factors associated with them are the virus itself, opportunistic infections (cytomegalovirus, which rather gives multiple mononeuropathies) and antiretroviral therapy [3] [5]- [7]. The prevalence of sensory polyneuropathy varies greatly according to the criteria used, and may reach 50% [8]- [11]. In Africa the unavailability of electromyography makes diagnosis more difficult, often based on clinical criteria.…”

“…This is the Brief Peripheral Neuropathy Screen (BPNS) with good diagnostic validity [13]- [15]. In Africa a few studies have used this tool [8]- [10]. In Gabon there are not to our knowledge the reliable data on the distal sensory polyneuropathy.…”

Role of TNF block genetic variants in HIV-associated sensory neuropathy in black Southern Africans

“…[3][4][5] Two recent studies in South Africa reported that about 60% of HIV-positive out-patients on ART had HIV-SN, and over two-thirds of these patients had a painful neuropathy. 6,7 While not fatal, HIV-SN has a significant negative impact on psychological, social and economic well-being 4 and there are no proven treatments for the pain. 8 The pathogenesis of HIV-SN has not been fully explained, but human [9][10][11] and animal studies 12 indicate that inflammation plays a central role.…”