Predictors of new-onset distal neuropathic pain in HIV-infected individuals in the era of combination antiretroviral therapy

Abstract

Despite modern combination antiretroviral therapy (CART), distal neuropathic pain (DNP) continues to affect many individuals with HIV infection. We evaluated risk factors for new onset DNP in the CNS Antiretroviral Therapy Effects Research (CHARTER) study, an observational cohort. Standardized, semi-annual clinical evaluations were administered at six U.S. sites. DNP was defined by using a clinician-administered instrument standardized across sites. All participants analyzed were free of DNP at study entry. New onset DNP was recorded at the first follow-up visit at which it was reported. Mixed effects logistic regression was used to evaluate potential predictors including HIV disease and treatment factors, demographics, medical comorbidities and neuropsychiatric factors. Among 493 participants, 131 (27%) reported new DNP over 2,306 visits during a median follow-up of 24 months [interquartile range (IQR) 12-42]. In multivariable regression, after adjusting for other covariates, significant entry predictors of new DNP were older age, female sex, current and past antiretroviral treatment, lack of virologic suppression, and lifetime history of opioid use disorder. During follow-up, more severe depression symptoms conferred a significantly elevated risk. The associations with opioid use disorders and depression reinforce the view that the clinical expression of neuropathic pain with peripheral nerve disease is strongly influenced by neuropsychiatric factors. Delineating such risk factors might help target emerging preventive strategies, for example, to individuals with a prior history of opioid use disorder, or might lead to new treatment approaches such as the use of tools to ameliorate depressed mood.

A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

“…The few studies on HIV-related chronic pain suggest that peripheral neuropathy is a major cause for this pain, affecting an estimated 27% of HIV patients (8). Risk factors for HIV-related neuropathic pain include current or former illicit drug abuse, HIV illness severity, older age, Black race/ethnicity, and use of specific classes of antiretroviral therapy (5, 8–10).…”

“…Risk factors for HIV-related neuropathic pain include current or former illicit drug abuse, HIV illness severity, older age, Black race/ethnicity, and use of specific classes of antiretroviral therapy (5, 8–10). …”

Clinical diagnosis of sensory neuropathy in HIV patients treated with tenofovir: A 6‐month follow‐up study

“…Indeed, one high-quality study suggested that asymptomatic SN may transition into symptomatic SN within a 12 to 24-month period on cART. 29 When symptomatic neuropathies developed within our cohort, they developed rapidly (most cases occurring within 3-months of initiating cART, and as early as 2 weeks), compared to asymptomatic neuropathies, which developed more slowly (most cases within ± 5-months of initiating cART). Rapid onset, painful neuropathies have also been reported in cohorts on other cART regimens including stavudine, zidovudine, and zalcitabine.…”

“…While the increase in the proportion with asymptomatic neuropathy is welcomed, this finding needs to be regarded with some caution: we only followed individuals for 6 months and so it is not clear if asymptomatic SN remained asymptomatic or whether it may have progressed to being symptomatic. Indeed, one high‐quality study suggested that asymptomatic SN may transition into symptomatic SN within a 12 to 24‐month period on cART . When symptomatic neuropathies developed within our cohort, they developed rapidly (most cases occurring within 3‐months of initiating cART, and as early as 2 weeks), compared to asymptomatic neuropathies, which developed more slowly (most cases within ± 5‐months of initiating cART).…”

Dor neuropática em pacientes com HIV/AIDS em uso de terapia antirretroviral

“…A maioria dos pacientes com HIV sentem dor e usam vários métodos para aliviá-la, mas com analgesia inadequada 63 . A dor neuropática é fortemente influenciada por desordens psiquiátricas 64 . A detecção do tratamento para depressão nos pacientes com dor neuropática distal moderada e grave é importante para o tratamento bem-sucedido dessa alteração 65 .…”