Alyssa C Vecchio1, Christina M Marra2, Jeffrey Schouten2,3, Hongyu Jiang4, Johnstone Kumwenda5, Khuanchai Supparatpinyo6, James Hakim7, Ned Sacktor8, Thomas B Campbell9, Srikanth Tripathy10, Nagalingeswaran Kumarasamy11, Alberto La Rosa12, Breno Santos13, Marcus T Silva14, Cecilia Kanyama15, Cindy Firnhaber9, Mina C Hosseinipour15, Rosie Mngqibisa16, Colin Hall1, Paola Cinque17, Kevin Robertson1. 1. Neurological HIV Center, University of North Carolina, Chapel Hill, North Carolina, USA. 2. Department of Neurology, University of Washington, Seattle, Washington, USA. 3. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington, USA. 4. Harvard Chan School of Public Health, Boston, Massachusetts, USA. 5. Queen Elizabeth College of Medicine-Johns Hopkins Project, Blantyre, Malawi. 6. Chiang Mai University, Chiang Mai, Thailand. 7. Department of Neurology, University of Zimbabwe, Harare, Zimbabwe. 8. Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA. 9. Department of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA. 10. National AIDS Research Institute, Pune, India. 11. Gaitonde Centre for AIDS Research and Education, Chennai, India. 12. Asociacion Civil Impacta Salud y Educacion Lima, Peru. 13. Hospital Conceicao, Porto Alegre, Brazil. 14. Fiocruz, Rio De Janeiro, Brazil. 15. UNC Project-Malawi, Lilongwe, Malawi. 16. Durban International Clinical Research Site, Durban, South Africa. 17. Neurovirology Unit, Universita Vita - Salute San Raffaele, Milan, Italy.
Abstract
BACKGROUND: Distal sensory peripheral neuropathy (DSPN) is a complication of human immunodeficiency virus (HIV). We estimate DSPN prevalence in 7 resource-limited settings (RLSs) for combination antiretroviral therapy (cART)-naive people living with HIV (PLWH) compared with matched participants not living with HIV and in PLWH virally suppressed on 1 of 3 cART regimens. METHODS: PLWH with a CD4+ count <300 cells/mm3 underwent standardized neurological examination and functional status assessments before and every 24 weeks after starting cART. Matched individuals not living with HIV underwent the same examinations once.Associations between covariates with DSPN at entry were assessed using the χ2 test, and virally suppressed PLWH were assessed using generalized estimating equations. RESULTS: Before initiating cART, 21.3% of PLWH had DSPN compared with 8.5% of people not living with HIV (n = 2400; χ2(df = 1) = 96.5; P < .00001). PLWH with DSPN were more likely to report inability to work [χ2(df = 1) = 10.6; P = .001] and depression [χ2(df = 1) = 8.9; P = .003] than PLWH without DSPN. Overall prevalence of DSPN among those virally suppressed on cART decreased: 20.3%, week 48; 15.3%, week 144; and 10.3%, week 192. Incident DSPN was seen in 127 PLWH. Longitudinally, DSPN was more likely in older individuals (P < .001) and PLWH with less education (P = .03). There was no significant association between cART regimen and DSPN. CONCLUSIONS: Although the prevalence of DSPN decreased following cART initiation in PLWH, further research could identify strategies to prevent or ameliorate residual DSPN after initiating cART in RLSs.
BACKGROUND: Distal sensory peripheral neuropathy (DSPN) is a complication of human immunodeficiency virus (HIV). We estimate DSPN prevalence in 7 resource-limited settings (RLSs) for combination antiretroviral therapy (cART)-naive people living with HIV (PLWH) compared with matched participants not living with HIV and in PLWH virally suppressed on 1 of 3 cART regimens. METHODS: PLWH with a CD4+ count <300 cells/mm3 underwent standardized neurological examination and functional status assessments before and every 24 weeks after starting cART. Matched individuals not living with HIV underwent the same examinations once.Associations between covariates with DSPN at entry were assessed using the χ2 test, and virally suppressed PLWH were assessed using generalized estimating equations. RESULTS: Before initiating cART, 21.3% of PLWH had DSPN compared with 8.5% of people not living with HIV (n = 2400; χ2(df = 1) = 96.5; P < .00001). PLWH with DSPN were more likely to report inability to work [χ2(df = 1) = 10.6; P = .001] and depression [χ2(df = 1) = 8.9; P = .003] than PLWH without DSPN. Overall prevalence of DSPN among those virally suppressed on cART decreased: 20.3%, week 48; 15.3%, week 144; and 10.3%, week 192. Incident DSPN was seen in 127 PLWH. Longitudinally, DSPN was more likely in older individuals (P < .001) and PLWH with less education (P = .03). There was no significant association between cART regimen and DSPN. CONCLUSIONS: Although the prevalence of DSPN decreased following cART initiation in PLWH, further research could identify strategies to prevent or ameliorate residual DSPN after initiating cART in RLSs.
Authors: K Robertson; H Jiang; J Kumwenda; K Supparatpinyo; S Evans; T B Campbell; R Price; S Tripathy; N Kumarasamy; A La Rosa; B Santos; M T Silva; S Montano; C Kanyama; S Faesen; R Murphy; C Hall; C M Marra; C Marcus; B Berzins; R Allen; M Housseinipour; F Amod; I Sanne; J Hakim; A Walawander; A Nair Journal: Clin Infect Dis Date: 2012-06-01 Impact factor: 9.079
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