The frequency of peripheral neuropathy in a group of HIV positive patients in Brazil

Zanetti, Claudia; Manzano, Gilberto Mastrocola; Gabbai, Alberto Alain

doi:10.1590/s0004-282x2004000200012

Cited by 17 publications

(19 citation statements)

References 30 publications

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“…Following are the comparison of our study with other studies (Table 6 and 7). 22,23 Some observations of our study go along with other studies. 24,25 For example the common type, distal symmetric polyneuropathy seen in other studies was also the common type in our study.…”

Section: Analysis Of Symptoms and Signssupporting

confidence: 85%

A study on peripheral neuropathy in HIV infected patients: clinicoepidemiological and electrophysiological profile

Gunasekaran

Sivakumar

2018

Int J Res Med Sci

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Background: Peripheral neuropathy is one among the commonest HIV-associated neurologic complications. The spectrum and the frequency of this complication are changing due to the introduction of new antiretroviral drugs, aging of the HIV-infected people, etc. Hence there is need for a better understanding of these complications and their pathogenesis. This study was done with the aim of finding out the risk factors, clinical characteristics and various types and patterns of peripheral neuropathy in HIV infected patients of our region.Methods: This study was a cross sectional study conducted for about a period of one year. Patients attending the out patient department of anti retroviral therapy (ART) centre were taken for the study. Selected patients were analysed for the signs and symptoms of peripheral neuropathy and they underwent electrophysiological study.Results: Prevalence of peripheral neuropathy in HIV infected patients in our study population was 43.3%. Peripheral neuropathy was seen more in patients with advanced clinical stage and increasing age. Distal symmetric polyneuropathy was the commonest type. Common pathological pattern of neuropathy was mixed (both axonal and demyelination) neuropathy.Conclusions: As peripheral neuropathy is a common HIV-associated neurologic complication, large number of studies are needed to elucidate the mechanisms leading to peripheral neuropathy in HIV infected patients, which in turn will allow for the development of effective therapies that provide adequate symptomatic relief and halt or reverse the damage to the nerves.

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Section: Analysis Of Symptoms and Signssupporting

confidence: 85%

A study on peripheral neuropathy in HIV infected patients: clinicoepidemiological and electrophysiological profile

Gunasekaran

Sivakumar

2018

Int J Res Med Sci

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“…Zanetti et al, described a prevalence of 69.4% in a cohort of HIVpositive patients in the city of São Paulo, Brazil (Zanetti et al, 2004). A subclinical peripheral neuropathy was disclosed in 64.7% of these patients, and this figure is in accordance with other authors (Marra et al, 1998).…”

Section: Epidemiology Of Neurological Complications Of Hiv Infectionsupporting

confidence: 63%

Highly active antiretroviral therapy access and neurological complications of human immunodeficiency virus infection: Impact versus resources in Brazil

Silva

Araújo²

2005

Journal of NeuroVirology

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Currently, there are almost 600,000 human immunodeficiency virus (HIV)-infected individuals in Brazil. From 1984 to 2004, 362,364 acquired immunodeficiency virus (AIDS) cases were officially reported and 155,000 patients are under highly active antiretroviral therapy (HAART) treatment. Like in developed countries, universal access to treatment in Brazil has definitively changed both mortality and morbidity of AIDS. Today, the median survival time is 58 months, with a 2-year survival of 63%, versus 18 months before HAART. As expected, the incidence of nervous system opportunistic infectious diseases and tumors has also decreased in Brazil. However, few Brazilian reports about neurological manifestations of HIV infection are available, particularly after the beginning of more effective antiretroviral therapy. Autopsy series report that toxoplasmosis is the most prevalent neurological disease, followed by cryptococcosis and HIV encephalitis. A much lower incidence of progressive multifocal leukoencephalopathy has been described in Brazil than in reports from developed countries. A possibility for this discrepancy could be differences in terms of JC virus (JCV) isolates or even the interactions between JCV and local HIV strains. Some particularities about the involvement of the nervous system in Brazilian patients are worthy of note, such as the occurrence of central nervous system involvement in chronic Chagas' disease in patients with AIDS, and the concomitance of leprosy and HIV infection. National surveillance of neurological manifestations of HIV infection is needed to ascertain the real impact of HAART on nervous system diseases associated with AIDS in Brazil.

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“…Our study supports the continued use of d‐drugs in developing countries, where large numbers of individuals are treated with d‐drug‐containing regimens because of their relatively low cost. The prevalence of neuropathy in resource‐limited settings appears similar to that found in the USA, ranging from 20% to 75% of HIV/AIDS patients, with similar increases in risk caused by increasing age and decreasing CD4 cell counts [13,16,20–23]. …”

Section: Discussionmentioning

confidence: 86%

Impact of long‐term treatment with neurotoxic dideoxynucleoside antiretrovirals: implications for clinical care in resource‐limited settings

et al. 2008

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A minority of HIV-infected patients taking an antiretroviral (ARV) regimen containing dideoxynucleosides (d-drugs) such as stavudine (d4T) and didanosine (DDI) experiences doselimiting neuropathic pain and paraesthesias, usually within weeks of starting these drugs. Because d-drugs are among the few affordable options available in developing countries, continuing d-drug therapy would be a desirable strategy for many HIV-infected individuals. Therefore, we evaluated the safety of continuing d-drug therapy. MethodsIn a US cohort, we compared the rates of worsening neuropathic symptoms and signs in HIVinfected individuals on stable ARV regimens that did (n 5 252) or did not (n 5 250) include d-drugs. Rates of worsening were compared using proportional hazards model and the log-rank test. ResultsThe risk ratios (RR) were not significantly larger for worsening neuropathy signs [0.94; 95% confidence interval (CI) 0.84-1.07] or symptoms (0.99; 95% CI 0.88-1.14) in patients taking d-drugs continuously compared to those not taking d-drugs. ConclusionsContinued d-drug exposure among patients tolerating an initial trial did not increase the risk of worsening neuropathy compared to non-d-drug-containing regimens. If applicable in developing countries, these findings suggest that in most patients d-drugs can be continued safely in the long term without increasing the risk of worsening neuropathy.Keywords: AIDS, dideoxynucleoside, HIV, neuropathy Received: 7 December 2007, accepted 29 April 2008 Introduction HIV-associated distal sensory-predominant polyneuropathy (DSPN) is an axon-length-dependent, painful, sensory neuropathy that often presents as paraesthesias and dysaesthesias in the feet [1][2][3][4]. Symptomatic DSPN is a frequent reason for patients to seek medical care, including analgesic therapy. Of all the neurological complications of HIV infection, DSPN is recognized most frequently by HIV care providers as having an impact on disability and antiretroviral (ARV) treatment choices.HIV is thought to cause peripheral neuropathy by increasing macrophage activation in the peripheral nervous system. The use of dideoxynucleoside analogues [d-drugs: didanosine (ddI), stavudine (d4T), and zalcitabine (ddC)] in the context of ARV treatment frequently contributes to or exacerbates DSPN 1,5-8. The best available evidence suggests that the pathophysiological basis for polyneuropathy from dideoxynucleosides is mitochondrial toxicity [9]. Dideoxynucleoside analogues contain azido groups that compete with natural thymidine triphosphate as substrates of DNA polymerase g. This competitive inhibition of DNA polymerase g may disrupt mitochondrial DNA synthesis [6], resulting in abnormal mitochondria as well as a significantly decreased quantity of mtDNA.Since highly active antiretroviral therapy (HAART) became widely available in 1996, HIV-related sensory Figure 1 depicts the criteria used to select patients for this analysis: a stable ARV regimen for at least two consecutive visits at which trained research nurses obtained comple...

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The frequency of peripheral neuropathy in a group of HIV positive patients in Brazil

Cited by 17 publications

References 30 publications

A study on peripheral neuropathy in HIV infected patients: clinicoepidemiological and electrophysiological profile

A study on peripheral neuropathy in HIV infected patients: clinicoepidemiological and electrophysiological profile

Highly active antiretroviral therapy access and neurological complications of human immunodeficiency virus infection: Impact versus resources in Brazil

Impact of long‐term treatment with neurotoxic dideoxynucleoside antiretrovirals: implications for clinical care in resource‐limited settings

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