Severity of HIV-associated neuropathy is associated with plasma HIV-1 RNA levels

Simpson, David M.; Haidich, Anna Bettina; Schifitto, Giovanni; Yiannoutsos, Constantin T.; Geraci, Anthony; McArthur, Justin C.; Katzenstein, David; Sacks, Henry S.; Khan, Amjad; Gerits, Pieter; Bartlett, J.; Maenza, Janine; Carter, K.; Becker, Rebecca L.; Rexrod, V.; Cohen, Bruce A.; Cooper, Charles K.; Murphy, Robert L.; Phair, John P.; Berger, JR; Ryan, Susanna; Nath, Avindra; Greenberg, Richard N.; Klenner, S.; Ryan, Máirín; Rc, Reichman; Kieburtz, Karl; Shoemaker, Megan L.; Navia, Bradford; Hirsch, Martin S.; McCarthy, Elizabeth; Flynn, Theresa; Adornato, Bruce T.; Slamowitz, Debbie; Valle, Sirkka‐Liisa; Norris, Joan H.; Rubin, Mark A.; Ponticello, Laura; Zaprianova, I.; Hall, C.; Kapoor, Catherine; Horst, Charles van der; Robertson, Wendy T.; Singer, Elyse J.; Miller, Elizabeth A.; Chafey, Suzette; Mitsuyasu, Ronald T.; McKendall, Robert R.; Pollard, Richard B.; Hollander, Harry; Jacobson, Mark A.; Price, Richard W.; McGuire, Dawn; Freimer, Miriam; Mendell, Jerry R.; Tucker, Miriam E.; Lederman, Michael M.; McVey, Rhona J; Davidson, Anne; Marra, Christina M.; Cummings, Dana; Collier, Ann C.; Clifford, David B.; Gray, Kimberly A; Glicksman, Marcie A.; Powderly, William G.; Hillman, Shauna; Caten, E.; Smith, Barbara A.; Shriver, S.; Millar, Linda; Rask, C. A.

doi:10.1097/00002030-200202150-00012

Cited by 82 publications

(27 citation statements)

References 17 publications

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“…Peak HIV viral load and CD4+ T-cell nadir were found to be risk factors for the development of HIV-DSP and also correlated with the severity of symptoms. 26 In studies comparing rates of HIV-DSP in cohorts studied before and after the introduction of ART, the prevalence of HIV-DSP is quite similar: 55% of pre-ART patients affected in the Dana cohort 27 and 53% of post-ART patients affected in the Manhattan HIV Brain Bank. 28 In the studies of HIV-DSP in patients in the ART era, the degree of immunosuppression no longer predicts the development or the severity of neuropathy.…”

Section: Epidemiologymentioning

confidence: 99%

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

Kranick

Nath²

2012

CONTINUUM: Lifelong Learning in Neurology

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Section: Epidemiologymentioning

confidence: 99%

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

Kranick

Nath²

2012

CONTINUUM: Lifelong Learning in Neurology

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“…[9][10][11] However, other studies have shown that d-drug ARV do not increase the risk or severity of DSP. 6,7,12 It is not clear whether mitochondrial mechanisms are responsible for d-drug ARV neurotoxicity. [13][14][15] There is considerable interest in the development of a reliable measure to establish the diagnosis and track the severity of DSP, particularly given the lack Additional material related to this article can be found on the Neurology Web site.…”

mentioning

confidence: 99%

“…Exclusion criteria included conditions other than HIV or neurotoxic ARV therapy that might confound the diagnosis of PN. These include diabetes mellitus necessitating oral hypoglycemic or insulin therapy; vitamin B 12 level of less than 200 pg/mL; alcoholism, defined by any alcohol-related medical complication within 6 months of study entry; and treatment with neurotoxins other than ARV, or potential neurotrophic agents, such as human growth hormone or acetyl carnitine derivatives.…”

mentioning

confidence: 99%

“…2 We have shown in a previous study that the severity of PN is also associated with high plasma HIV RNA levels. 12 Therefore, in the current study, we selected subjects with advanced HIV disease, and who were ARV experienced, with the assumption that these subjects were at highest risk for progressive PN, or for transitioning from a neuropathy-free state to incident PN. However, multivariate analysis revealed that neither CD4 cell count nor plasma HIV viral load was correlated with the presence or progression of PN.…”

mentioning

confidence: 99%

“…[9][10][11] However, more recent trials have shown that d-drug ARV did not add further risk to the occurrence of HIVassociated PN. [5][6][7]12 Therefore, it is not clear how best to predict which patients are at highest risk for the development of DSP while being treated with d-drug ARV regimens. Although the use of d-drug ARV is declining in the United States because of the availability of alternate ARV agents with less toxicity, they remain an important component of first-line ARV regimens in the developing world.…”

mentioning

confidence: 99%

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Pulsatile tinnitus from a redundant arterial loop

Libman¹,

Johnson²

2006

Neurology

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Abstract-Background: Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy. Methods: The authors evaluated 101 subjects with advanced HIV infection over 48 weeks. Assessments included a brief peripheral neuropathy (PN) screen (BPNS), neurologic examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsies with quantitation of epidermal nerve fiber density. Data were summed into a Total Neuropathy Score (TNS). The presence, severity, and progression of DSP were related to clinical and laboratory results. Results: The mean TNS (range 0 to 36) was 8.9, with 38% of subjects classified as PN-free, 10% classified as having asymptomatic DSP, and 52% classified as having symptomatic DSP. Progression in TNS from baseline to week 48 occurred only in the PN-free group at baseline (mean TNS change ϭ 1.16 Ϯ 2.76, p ϭ 0.03). Factors associated with progression in TNS were lower current TNS, distal epidermal denervation, and white race. As compared with the TNS diagnosis of PN at baseline, the BPNS had a sensitivity of 34.9% and a specificity of 89.5%. Conclusions: In this cohort of advanced human immunodeficiency virus (HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy (DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.

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HIV-Associated Distal Sensory Polyneuropathy in the Era of Highly Active Antiretroviral Therapy

Morgello

Estanislao²,

Simpson³

et al. 2004

Arch Neurol

193

118

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In contrast to populations before the era of highly active antiretroviral therapy, DSP in the Manhattan HIV Brain Bank cohort is not associated with increased viral load or decreased CD4 cell counts in this cross-sectional analysis. Symptoms in DSP are associated with substance use disorders, but no difference in morphologic structure is seen in nerves of patients with HIV infection with and without substance use histories. Previously reported virologic and immunologic underpinnings of DSP may be affected by highly active antiretroviral therapy. Furthermore, symptoms of DSP in substance users may be altered by central mechanisms of increased or decreased tolerance to sensory disturbance.

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Severity of HIV-associated neuropathy is associated with plasma HIV-1 RNA levels

Cited by 82 publications

References 17 publications

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

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

Pulsatile tinnitus from a redundant arterial loop

HIV-Associated Distal Sensory Polyneuropathy in the Era of Highly Active Antiretroviral Therapy

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