Prevalence of and risk factors for HIV‐associated neuropathy in Melbourne, Australia 1993–2006

Abstract

Objectives The aim of the study was to describe the prevalence of and risk factors for HIV‐associated sensory neuropathy (HIV‐SN) in 2006 [the era of stavudine, didanosine and zalcitabine (dNRTI)‐sparing highly active antiretroviral therapy (HAART)] and to compare our findings with data obtained in the same clinic in 1993 (pre‐HAART) and 2001 (frequent use of dNRTI‐containing HAART). Methods This was a cross‐sectional comparative study using convenience sampling. HIV‐positive adults attending a tertiary referral clinic over a 2‐week period were screened for HIV‐SN using the AIDS Clinical Trials Group screening tool. HIV‐SN was defined as present if the patient had both neuropathic symptoms and abnormal signs. Demographic, clinical, laboratory and treatment data were considered as possible risk factors for HIV‐SN, and results were compared with data obtained in the same clinic in 1993 and 2001. Results One hundred patients were screened. The prevalence of HIV‐SN was 42%, which was unchanged since 2001 (44%) despite a significant reduction in the use of dNRTIs. HIV‐SN remained much more common than in 1993 (42% vs 13%; P<0.0001). The only independent associations with HIV‐SN in 2006 were increasing patient age and a history of exposure to either stavudine or indinavir. This compares with 1993 when neuropathy was increased in those with Mycobacterium avium complex infection, and 2001 when patient age and use of stavudine and didanosine were the independent associations with HIV‐SN in this clinic. Conclusions HIV‐SN remained common among ambulatory patients in 2006 (42% prevalence) despite a significant reduction in the use of dNRTIs. In addition to patient age and stavudine exposure, indinavir use may be a risk factor for HIV‐SN.

Neurologic Complications of HIV-1 Infection and Its Treatment in the Era of Antiretroviral Therapy

“…Painful paresthesia is common in this syndrome; in one study of 100 patients screened during 2 weeks in Australia, 42% of patients had a distal sensory neuropathy, and of these, 93% reported painful symptoms. 29 As a small fiber sensory neuropathy, pathologic changes may be absent on EMG and nerve conduction studies, thus requiring skin biopsy for definitive diagnosis. In most cases, classic symptoms in the appropriate clinical context are sufficient to formulate a diagnosis and treatment plan.…”

Cytokine Genotype Suggests a Role for Inflammation in Nucleoside Analog-Associated Sensory Neuropathy (NRTI-SN) and Predicts an Individual's NRTI-SN Risk

“…Clinical details including age, 2,3 plasma lactate 24 exposure to protease inhibitors, 25,26 and perhaps hepatitis C status 27 have previously been associated with NRTI-SN risk. Demographic details of study patients (n ϭ 55, Table 4A) identify patient height as the only feature associated with NRTI-SN status (p ϭ 0.0001).…”

Incident Neuropathy in HIV-Infected Patients on HAART

“…11 It is well established that DSP continues to be a prevalent neurologic complication associated with HIV infection in the HAART era, occurring in 36-62% of subjects infected with HIV. [1][2][3][4] Little is known about the incidence of DSP in the era of HAART. Lichtenstein et al 13 reported an incidence of five cases per 100 person-years from the HIV Outpatient Study (HOPS).…”

“…1). Given that d-drugs, especially d4T, are still used in resource-limited settings 4,29,30 and some believe that the relationship between d-drugs and the development of symptomatic DSP results from the unmasking of preexisting subclinical peripheral nerve damage by the toxic agents, future studies to determine risk factors involved with the development of symptomatic DSP and progression of an asymptomatic to symptomatic DSP are warranted. Cherry et al 30 and Affandi et al 29 found that d4T neuropathy risk increases with age and height and suggest that prioritizing older and taller subjects to alternative antiviral therapies would be one inexpensive strategy to reduce DSP in resource-limited settings.…”

“…1 Nonetheless, HIV-associated distal sensory neuropathy (DSP) continues to be a common neurologic complication seen in HIV-seropositive individuals. [2][3][4] Patients usually present with the gradual onset of distal sensory symptoms in the feet, including numbness, paresthesias, or painful dysesthesias. 5 The painful dysesthesias can be severe enough to limit activities of daily living.…”