Michelle Kvalsund1, Takondwa Chidumayo2, Johanna Hamel3, David Herrmann4, Douglas Heimburger5, Amanda Peltier6, Gretchen Birbeck7. 1. International Neurologic & Psychiatric Epidemiology Program, Department of Neurology & Ophthalmology, Michigan State University, 909 West Fee Road, Room 324, East Lansing, MI 48824, USA; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia, Nationalist Road, P.O. Box 50110, Lusaka, Zambia. Electronic address: Michelle.Kvalsund@hc.msu.edu. 2. Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia, Nationalist Road, P.O. Box 50110, Lusaka, Zambia. 3. Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: johanna_hamel@urmc.rochester.edu. 4. Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: David_Herrmann@URMC.Rochester.edu. 5. Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 Westend- Suite 725, Nashville, TN 37203, USA. Electronic address: douglas.heimburger@Vanderbilt.Edu. 6. Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37203, USA. Electronic address: amanda.peltier@Vanderbilt.Edu. 7. Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA; Epilepsy Care Team, Chikankata Health Services, Mazabuka, Zambia. Electronic address: gretchen_birbeck@urmc.rochester.edu.
Abstract
BACKGROUND: Non-antiretroviral (ART) drug exposures and poor nutrition may be important modifiable risk factors for distal symmetric polyneuropathies (DSP) in sub-Saharan Africa. METHODS: We conducted a cross-sectional study of DSP prevalence and factors associated with DSP among clinic attendees in urban and rural Zambia. All participants underwent neurologist-performed examination. Laboratory investigations seeking comorbid risk factors for DSP were performed for DSP cases. RESULTS: We identified 31/137 (22.6%) HIV+ and 21/177 (11.9%) HIV- DSP cases. DSP prevalence did not differ by urbanicity, although rural participants were significantly more likely to have one asymptomatic DSP sign. Low dietary diversity, history of syphilis, history of tuberculosis, and prior metronidazole and ciprofloxacin use were associated with DSP amongst HIV+ cases, while age and education were associated with DSP in HIV- participants (all p-values < 0·05). In a multivariate logistic regression model, HIV (p = 0·0001) and age (p < 0·0001), and ciprofloxacin exposure (p = 0·01) remained independently associated with DSP. While diabetes was rare, supoptimal micronutrients levels were common among DSP cases regardless of HIV status. CONCLUSIONS: While HIV infection is strongly associated with DSP in Zambia, history of non-ART drug exposures and low dietary diversity are also important determinants of DSP in HIV+ individuals. Treatable micronutrient deficiencies were common.
BACKGROUND: Non-antiretroviral (ART) drug exposures and poor nutrition may be important modifiable risk factors for distal symmetric polyneuropathies (DSP) in sub-Saharan Africa. METHODS: We conducted a cross-sectional study of DSP prevalence and factors associated with DSP among clinic attendees in urban and rural Zambia. All participants underwent neurologist-performed examination. Laboratory investigations seeking comorbid risk factors for DSP were performed for DSP cases. RESULTS: We identified 31/137 (22.6%) HIV+ and 21/177 (11.9%) HIV- DSP cases. DSP prevalence did not differ by urbanicity, although rural participants were significantly more likely to have one asymptomatic DSP sign. Low dietary diversity, history of syphilis, history of tuberculosis, and prior metronidazole and ciprofloxacin use were associated with DSP amongst HIV+ cases, while age and education were associated with DSP in HIV- participants (all p-values < 0·05). In a multivariate logistic regression model, HIV (p = 0·0001) and age (p < 0·0001), and ciprofloxacin exposure (p = 0·01) remained independently associated with DSP. While diabetes was rare, supoptimal micronutrients levels were common among DSP cases regardless of HIV status. CONCLUSIONS: While HIV infection is strongly associated with DSP in Zambia, history of non-ART drug exposures and low dietary diversity are also important determinants of DSP in HIV+ individuals. Treatable micronutrient deficiencies were common.
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