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Bush K, Wairkar Y, Tang SJ. Nucleoside Reverse Transcriptase Inhibitors Are the Major Class of HIV Antiretroviral Therapeutics That Induce Neuropathic Pain in Mice. Int J Mol Sci 2024; 25:9059. [PMID: 39201745 PMCID: PMC11354254 DOI: 10.3390/ijms25169059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 09/03/2024] Open
Abstract
The development of combination antiretroviral therapy (cART) has transformed human immunodeficiency virus (HIV) infection from a lethal diagnosis into a chronic disease, and people living with HIV on cART can experience an almost normal life expectancy. However, these individuals often develop various complications that lead to a decreased quality of life, some of the most significant of which are neuropathic pain and the development of painful peripheral sensory neuropathy (PSN). Critically, although cART is thought to induce pain pathogenesis, the relative contribution of different classes of antiretrovirals has not been systematically investigated. In this study, we measured the development of pathological pain and peripheral neuropathy in mice orally treated with distinct antiretrovirals at their translational dosages. Our results show that only nucleoside reverse transcriptase inhibitors (NRTIs), not other types of antiretrovirals such as proteinase inhibitors, non-nucleoside reverse transcriptase inhibitors, integrase strand transfer inhibitors, and CCR5 antagonists, induce pathological pain and PSN. Thus, these findings suggest that NRTIs are the major class of antiretrovirals in cART that promote the development of neuropathic pain. As NRTIs form the essential backbone of multiple different current cART regimens, it is of paramount clinical importance to better understand the underlying mechanism to facilitate the design of less toxic forms of these drugs and/or potential mitigation strategies.
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Affiliation(s)
- Keegan Bush
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Yogesh Wairkar
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Shao-Jun Tang
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
- Stony Brook University Pain and Analgesia Research Center and Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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Zahr NM. Race explains substantial variance in whole blood thiamine diphosphate concentrations. Nutr Res 2024; 126:138-150. [PMID: 38696890 PMCID: PMC11179978 DOI: 10.1016/j.nutres.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 05/04/2024]
Abstract
Deficiency for thiamine (vitamin B1), traditionally assessed via the activity of the thiamine-dependent enzyme erythrocyte transketolase, has been reported in individuals with alcohol use disorder (AUD) and in people with HIV; concentrations of the metabolically active diphosphate form, however, have yet to be reported in HIV cohorts and results in AUD are equivocal. In this cross-sectional study, samples from 170 AUD, 130 HIV, and 100 healthy control individuals were analyzed to test the hypothesis that AUD and HIV groups relative to healthy controls would show low whole blood thiamine diphosphate (TDP) concentrations related to peripheral neuropathy. TDP concentrations were not different in the 3 study groups (P = .6141) but were lower in Black (n = 172) relative to White (n = 155) individuals (P < .0001) regardless of group. In a multiple regression, race relative to diagnoses explained more than 10 times the variance in whole blood TDP concentrations (F4,395 = 3.5, P = .0086; r2 = 15.1]. Performance on a measure of peripheral neuropathy (2-point discrimination) was worse in the HIV and AUD cohorts relative to the healthy control group (P < .0001) but was not associated with TDP concentrations. These findings suggest that Black individuals carry a heightened vulnerability for low whole blood TDP concentrations, but the clinical significance and mechanisms underlying these results remain to be determined.
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Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA 94305, USA; Neuroscience Program, SRI International, Menlo Park, CA, 94025, USA.
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Sowanou A, Ungureanu A, Aguesse C. Recurrent reversible cerebral vasoconstriction syndrome and antiphospholipid syndrome. Acta Neurol Belg 2024; 124:329-334. [PMID: 37392321 DOI: 10.1007/s13760-023-02324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Arlos Sowanou
- Neurology Department, Centre Hospitalier Alpes-Léman, Contamine Sur Arve, France
| | - Aurelian Ungureanu
- Neurology Department, Centre Hospitalier Alpes-Léman, Contamine Sur Arve, France.
| | - Claire Aguesse
- Neurology Department, Centre Hospitalier Alpes-Léman, Contamine Sur Arve, France
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Schuldt AL, Bern H, Hart M, Gompels M, Winston A, Clarke A, Chen F, Stöhr W, Heslegrave A, Paton NI, Petzold A, Arenas-Pinto A. Peripheral Neuropathy in Virologically Suppressed People Living with HIV: Evidence from the PIVOT Trial. Viruses 2023; 16:2. [PMID: 38275937 PMCID: PMC10818628 DOI: 10.3390/v16010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024] Open
Abstract
The aim of this study is to identify the factors associated with peripheral neuropathy and to explore neurofilament light chain (NfL) as a biomarker for peripheral neuropathy (PN) in effectively virologically suppressed adults living with HIV. All protease inhibitor monotherapy versus ongoing triple therapy in the long-term management of HIV infection (PIVOT) trial participants with data on PN at baseline were included in the study. NfL plasma levels (pNfL) were measured in a sub-set of participants. Multivariable logistic regression was used to examine the associations of PN with potential risk factors (including age, sex, nadir CD4 cell count, history of dideoxynucleoside (d-drugs) exposure, and blood glucose levels) and NfL levels. Of the 585 participants included, 131 (22.4%) reported PN during the study period (median of 44 months). The participants were predominantly male (76.6%), White (68.2%), and virologically suppressed for a median period of 37 months (range of 20-63) before recruitment. The age at baseline was 44.3 years (standard deviation (SD) of 9.2). PN was independently associated with age (adjusted odds ratio (aOR) = 1.35, 95% CI of 1.20-1.52; additional 5 years), history of d-drugs (aOR 1.88, 95% CI of 1.12-3.16), height (aOR 1.19, 95% CI of 1.05-1.35; additional 5 cm), nadir CD4 cell count (aOR 1.10 CI of 1.00-1.20; 50 cells fewer), and metabolic syndrome (aOR 2.31, 95% CI of 1.27 4.20), but not pNfL. The excess risk for PN associated with d-drug use remains after the exposure has stopped for years, suggesting non-reversible toxicity. In people with HIV, metabolic syndrome is independently associated with PN. There was no additional value for pNfL as a screening test for peripheral neuropathy in effectively virologically suppressed adults living with HIV.
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Affiliation(s)
- Anna L. Schuldt
- Institute for Global Health, University College London, London WC1E 6JB, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, University College London, London WC1V 6LJ, UK (W.S.)
| | - Melanie Hart
- Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (M.H.); (A.H.); (A.P.)
| | - Mark Gompels
- Service of Immunology, Southmead Hospital, Bristol BS10 5NB, UK
| | - Alan Winston
- Faculty of Medicine, Imperial College London, London SW7 2BX, UK;
| | - Amanda Clarke
- Department of HIV, Sexual Health and Contraception, Brighton and Sussex University Hospitals NHS Trust, Brighton BN11 2DH, UK;
| | - Fabian Chen
- Florey Unit Clinic for Sexual Health, Royal Berkshire Hospital, Reading RG1 5AN, UK;
| | - Wolfgang Stöhr
- MRC Clinical Trials Unit at UCL, University College London, London WC1V 6LJ, UK (W.S.)
| | - Amanda Heslegrave
- Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (M.H.); (A.H.); (A.P.)
| | - Nicholas I. Paton
- MRC Clinical Trials Unit at UCL, University College London, London WC1V 6LJ, UK (W.S.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Axel Petzold
- Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (M.H.); (A.H.); (A.P.)
| | - Alejandro Arenas-Pinto
- Institute for Global Health, University College London, London WC1E 6JB, UK
- MRC Clinical Trials Unit at UCL, University College London, London WC1V 6LJ, UK (W.S.)
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Kwak SY, Boudier-Revéret M, Chang MC. Out of Sight, Out of Diagnosis-Severe Bilateral Neuropathic Pain in Lower Limbs of a 64-Yr-Old Man. Am J Phys Med Rehabil 2023; 102:e50-e53. [PMID: 36228189 DOI: 10.1097/phm.0000000000002115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Seong Yeob Kwak
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea (SYK, MCC); and Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada (MB-R)
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Wang J, Zhang Y, Wang M, Ren Y, Tang M, Liu L, Zhou D. Intravenous immunoglobulin therapy for HIV-associated Guillain-Barré syndrome. Int Immunopharmacol 2022; 112:109192. [PMID: 36155283 DOI: 10.1016/j.intimp.2022.109192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the efficacy of intravenous immunoglobulin (IVIG) added to antiretroviral therapy (ART) and ART alone in people living with human immunodeficiency virus-associated Guillain-Barré syndrome (HIV-associated GBS). METHODS The study was a retrospective analysis of clinical records of HIV-associated GBS patients from department of neurology at West China Hospital between January 2015 and October 2020. Patients treated with ART alone were compared with those treated with IVIG + ART. The primary outcome was the GBS disability score at 4 weeks, which was assessed with multivariable ordinal regression. Additional outcomes include the GBS disability scale at 1 week, improvement of ≥ 1 point on the GBS disability score at 1 and 4 weeks, median change in the MRC sum score at 1 and 4 weeks, number of patients who were able to walk independently at 4 weeks. RESULTS Two hundred and fifty-two (252) individuals living with HIV were recruited in the study. According to the inclusion and exclusion criteria, 21 HIV-associated GBS patients were finally included, of whom 8 were treated with IVIG + ART and 13 were treated with ART alone. At the fourth weeks after treatment, the GBS disability scale grade was significantly lower in patients treated with IVIG + ART than those with ART alone (1 vs. 2, P = 0.02). The adjusted OR for a lower GBS disability scale was 10.6 (95 % CI 1.15 to 98.05; P = 0.03) for the IVIG + ART group. Moreover, 6 of 8 (75 %) patients treated with IVIG + ART were able to walk independently at four weeks after treatment. CONCLUSIONS The introduction of IVIG combined with ART may be efficacious in the treatment of HIV-infected GBS and may provide better clinical outcomes.
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Affiliation(s)
- Jierui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, Sichuan, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Ren
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng Tang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Becker WC, Li Y, Caniglia EC, Vickers-Smith R, Feinberg T, Marshall BD, Edelman EJ. Cannabis use, pain interference, and prescription opioid receipt among persons with HIV: a target trial emulation study. AIDS Care 2022; 34:469-477. [PMID: 34180721 PMCID: PMC10450359 DOI: 10.1080/09540121.2021.1944597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Concomitant with expanded legalization, cannabis is increasingly used to treat chronic pain among persons with HIV (PWH), despite equivocal benefit in research limited by small sample sizes and short duration of follow-up. To address these limitations, among a sample of PWH with pain interference enrolled in the Veterans Aging Cohort Study, we performed a target trial emulation study to compare the impact of four cannabis use strategies on pain interference. Among those receiving long-term opioid therapy (LTOT), we also explored impact of these strategies on ≥ 25% LTOT dose reduction. Among the analytic sample (N = 1284), the majority were men with a mean age of 50. Approximately 31% used cannabis and 12% received LTOT at baseline. Adjusting for demographic and clinical factors, cannabis use in any of 4 longitudinal patterns was not associated with resolved pain interference over 12- to 24-month follow-up. Among 153 participants receiving LTOT at baseline, cannabis use at both baseline and follow-up was negatively associated with LTOT dose reduction compared to no use at both baseline and follow-up. These findings support other observational studies finding no association between cannabis use and improved chronic pain or LTOT reduction among PWH.
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Affiliation(s)
- William C. Becker
- VA Connecticut Healthcare System, 950 Campbell Avenue, Mail Stop 151B, West Haven, CT 06516, USA
- Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Yu Li
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02912, USA
| | | | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY 40536
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40508
| | - Termeh Feinberg
- VA Connecticut Healthcare System, 950 Campbell Avenue, Mail Stop 151B, West Haven, CT 06516, USA
- Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02912, USA
| | - E. Jennifer Edelman
- Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06510, USA
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Kuka WP, Shah J, Alam U, Shah R, Sokhi DS. Clinical Characteristics of Peripheral Neuropathy in Kenyan Patients with HIV Infection Compared with Patients with Concurrent HIV Infection and Diabetes Mellitus. Diabetes Ther 2022; 13:441-451. [PMID: 35157232 PMCID: PMC8934803 DOI: 10.1007/s13300-022-01205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Persons living with human immunodeficiency virus (HIV) are living longer and at risk of non-communicable diseases, including diabetes mellitus (DM). Both HIV and DM place patients at risk of peripheral neuropathy (PN). Our aim was to demonstrate the prevalence and characteristics of PN in our population of patients with HIV infection compared with concomitant HIV and DM. METHODS A prospective cross-sectional study was performed at the Aga Khan Hospital in Nairobi, Kenya. Data were collected on demographics and characteristics of DM and HIV. Symptoms and signs of PN were evaluated by Neuropathy Symptom Score, Neuropathy Disability Score, and 10 g monofilament testing. RESULTS Two groups were recruited, each consisting of 68 patients: (1) HIV only, (2) HIV and DM. The median age of patients was 51 years (IQR 42.8-58.6) and 55% were male. Median duration for HIV was 10 years (IQR 5-12) with a median CD4 count of 524 cells/mm3 (IQR 369-731). Median duration for DM was 1 year with a median glycosylated hemoglobin of 6.7% (IQR 6.6-7.6). Sixty-nine percent of patients with HIV had suppressed viral loads, and 9 patients (6.6%) had a history neurotoxic antiretroviral therapy use. PN was detected in 11 (16%) HIV-only patients, and in 17 (25%) participants who had both HIV and DM (Fisher exact test chi-square = 0.4). Univariate analysis demonstrated older age, high body mass index, and long duration of HIV were associated with an OR of 1.07 (95% CI 1.02-1.11), 1.21 (95% CI 0.46-3.11), and 1.07 (95% CI 0.99-1.15) in the overall group, respectively. CONCLUSION Our study demonstrates a higher but non-significant prevalence of PN in patients with both HIV and DM when compared to HIV alone. HIV disease control had no association with PN presence.
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Affiliation(s)
- Werimo Pascal Kuka
- Department of Medicine, Aga Khan University Medical College East Africa, 4th Floor East Tower Block, Third Avenue Parklands, P.O. Box 30270, Nairobi, 00100, GPO, Kenya.
| | - Jasmit Shah
- Department of Medicine, Aga Khan University Medical College East Africa, 4th Floor East Tower Block, Third Avenue Parklands, P.O. Box 30270, Nairobi, 00100, GPO, Kenya
| | - Uazman Alam
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
- Diabetes and Endocrinology Research, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Reena Shah
- Department of Medicine, Aga Khan University Medical College East Africa, 4th Floor East Tower Block, Third Avenue Parklands, P.O. Box 30270, Nairobi, 00100, GPO, Kenya
| | - Dilraj Singh Sokhi
- Department of Medicine, Aga Khan University Medical College East Africa, 4th Floor East Tower Block, Third Avenue Parklands, P.O. Box 30270, Nairobi, 00100, GPO, Kenya
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Fattori V, Ferraz CR, Rasquel-Oliveira FS, Verri WA. Neuroimmune communication in infection and pain: Friends or foes? Immunol Lett 2020; 229:32-43. [PMID: 33248166 DOI: 10.1016/j.imlet.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/02/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
Clinically, a variety of micro-organisms cause painful infections. Before seen as bystanders in the context of infections, recent studies have demonstrated that, as immune cells, nociceptors can sense pathogen-derived products. Nociceptors and immune cells, therefore, have evolved to communicate with each other to control inflammatory and host responses against pathogens in a complementary way. This interaction is named as neuroimmune communication (or axon-axon immune reflex) and initiates after the release of neuropeptides, such as CGRP and VIP by neurons. By this neurogenic response, nociceptors orchestrate the activity of innate and adaptive immune cells in a context-dependent manner. In this review, we focus on how nociceptors sense pathogen-derived products to shape the host response. We also highlight the new concept involving the resolution of inflammation, which is related to an active and time-dependent biosynthetic shift from pro-inflammatory to pro-resolution mediators, the so-called specialized pro-resolving lipid mediators (SPMs). At very low doses, SPMs act on specific receptors to silence nociceptors, limit pain and neurogenic responses, and resolve infections. Furthermore, stimulation of the vagus nerve induces SPMs production to regulate immune responses in infections. Therefore, harnessing the current understanding of neuro-immune communication and neurogenic responses might provide the bases for reprogramming host responses against infections through well balanced and effective immune response and inflammation resolution.
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Affiliation(s)
- Victor Fattori
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Londrina State University, Londrina, PR, Brazil; Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Camila R Ferraz
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Londrina State University, Londrina, PR, Brazil
| | - Fernanda S Rasquel-Oliveira
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Londrina State University, Londrina, PR, Brazil
| | - Waldiceu A Verri
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Londrina State University, Londrina, PR, Brazil.
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Basheer A, Kirubakaran R, Tan K, Vishnu VY, Fialho D. Disease-modifying therapy for HIV-related distal symmetrical polyneuropathy (including antiretroviral toxic neuropathy). Hippokratia 2020. [DOI: 10.1002/14651858.cd013716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Aneesh Basheer
- Department of Medicine; Pondicherry Institute of Medical Sciences; Pondicherry India
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy; Christian Medical College; Vellore India
| | - Kevin Tan
- National Neuroscience Institute; Singapore Singapore
| | - Venugopalan Y Vishnu
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Doreen Fialho
- Department of Clinical Neurophysiology; King's College Hospital; London UK
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Sanna MD, Manassero G, Vercelli A, Herdegen T, Galeotti N. The isoform-specific functions of the c-Jun N-terminal kinase (JNK) in a mouse model of antiretroviral-induced painful peripheral neuropathy. Eur J Pharmacol 2020; 880:173161. [DOI: 10.1016/j.ejphar.2020.173161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/30/2020] [Accepted: 04/28/2020] [Indexed: 01/26/2023]
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Mangus LM, Weinberg RL, Knight AC, Queen SE, Adams RJ, Mankowski JL. SIV-Induced Immune Activation and Metabolic Alterations in the Dorsal Root Ganglia During Acute Infection. J Neuropathol Exp Neurol 2019; 78:78-87. [PMID: 30500918 DOI: 10.1093/jnen/nly111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus-associated sensory neuropathy (HIV-SN) remains a frequent neurologic complication of HIV infection. Little is known about alterations in the peripheral nervous system during the early stages of HIV, a time when neuroprotective interventions may be most beneficial. We performed Nanostring gene expression analysis on lumbar dorsal root ganglia (DRG) from 6 simian immunodeficiency virus (SIV)-infected pigtailed macaques killed at 7 days post-inoculation and 8 uninfected controls. We found significant upregulation of many genes involved in immune signaling and activation in the DRG. Among genes related to glutamate metabolism, there was significant upregulation of glutamine synthetase (GS), while glutaminase (GLS) was downregulated. Several genes involved in the oxidative stress response also showed significant differential regulation in the DRG of 7d SIV-infected animals, with superoxide dismutase-2 (SOD2) showing the greatest median fold change compared to controls. Novel findings in the DRG were compared to corresponding brain data and further investigated at the protein level by Western blotting and immunohistochemistry. Together with our previous finding of significant epidermal nerve fiber loss at 14 days post-SIV infection, results of this study demonstrate that immune activation and altered cellular metabolism at in the DRG precede and likely contribute to early sensory nerve injury in HIV-SN.
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Affiliation(s)
- Lisa M Mangus
- Department of Molecular and Comparative Pathobiology
| | | | | | | | | | - Joseph L Mankowski
- Department of Molecular and Comparative Pathobiology.,Department of Neurology.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zahr NM, Pohl KM, Pfefferbaum A, Sullivan EV. Dissociable Contributions of Precuneus and Cerebellum to Subjective and Objective Neuropathy in HIV. J Neuroimmune Pharmacol 2019; 14:436-447. [PMID: 30741374 PMCID: PMC6689464 DOI: 10.1007/s11481-019-09837-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/25/2019] [Indexed: 01/22/2023]
Abstract
Neuropathy, typically diagnosed by the presence of either symptoms or signs of peripheral nerve dysfunction, remains a frequently reported complication in the antiretroviral (ART)-treated HIV population. This study was conducted in 109 healthy controls and 57 HIV-infected individuals to investigate CNS regions associated with neuropathy. An index of objective neuropathy was computed based on 4 measures: deep tendon ankle reflex, vibration sense (great toes), position sense (great toes), and 2-point discrimination (feet). Subjective neuropathy (self-report of pain, aching, or burning; pins and needles; or numbness in legs or feet) was also evaluated. Structural MRI data were available for 126/166 cases. The HIV relative to the healthy control group was impaired on all 4 signs of neuropathy. Within the HIV group, an objective neuropathy index of 1 (bilateral impairment on 1 measure) or 2 (bilateral impairment on at least 2/4 measures) was associated with older age and a smaller volume of the cerebellar vermis. Moderate to severe symptoms of neuropathy were associated with more depressive symptoms, reduced quality of life, and a smaller volume of the parietal precuneus. This study is consistent with the recent contention that ART-treated HIV-related neuropathy has a CNS component. Distinguishing subjective symptoms from objective signs of neuropathy allowed for a dissociation between the precuneus, a brain region involved in conscious information processing and the vermis, involved in fine tuning of limb movements. Graphical Abstract In HIV patients, objective signs of neuropathy correlated with smaller cerebellar vermis (red) volumes whereas subjective symptoms of neuropathy were associated with smaller precuneus (blue) volumes.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA.
| | - Kilian M Pohl
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
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Puplampu P, Ganu V, Kenu E, Kudzi W, Adjei P, Grize L, Käser M. Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana. J Neurovirol 2019; 25:464-474. [PMID: 31028691 PMCID: PMC6746675 DOI: 10.1007/s13365-019-00743-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/01/2019] [Accepted: 03/21/2019] [Indexed: 01/11/2023]
Abstract
Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38-10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26-0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36-1.83 and aOR = 2.17; 95% CI 0.93-5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS' quality of life.
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Affiliation(s)
- Peter Puplampu
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
| | - William Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Michael Käser
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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Sensitivity and specificity of the Neuropad for distal sensory peripheral neuropathy (DSPN) in subjects with HIV-Infection: A case controlled observational study. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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16
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Yi Z, Ouyang S, Zhou C, Xie L, Fang Z, Yuan H, Yang J, Zou L, Jia T, Zhao S, Li L, Shi L, Gao Y, Li G, Liu S, Xu H, Xu C, Zhang C, Liang S. Andrographolide Inhibits Mechanical and Thermal Hyperalgesia in a Rat Model of HIV-Induced Neuropathic Pain. Front Pharmacol 2018; 9:593. [PMID: 29950989 PMCID: PMC6008568 DOI: 10.3389/fphar.2018.00593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/17/2018] [Indexed: 12/17/2022] Open
Abstract
Aim: In this study, we investigated whether andrographolide (Andro) can alleviate neuropathic pain induced by HIV gp120 plus ddC treatment and the mechanism of its action. Methods: The paw withdrawal threshold and the paw withdrawal latency were observed to assess pain behaviors in all groups of the rats, including control group, control combined with Andro treatment group, sham group, gp120 combined with ddC treatment group, gp120 plus ddC combined with A438079 treatment group, and gp120 plus ddC combined with Andro treatment by intrathecally injecting at a dose of 25 μg/20 μl group. The protein expression levels of the P2X7 receptor, tumor necrosis factor-α-receptor (TNFα-R), interleukin-1β (IL-1β), IL-10, phospho-extracellular regulated protein kinases (ERK) (p-ERK) in the L4-L6 dorsal root ganglia (DRG) were measured by western blotting. Real-time quantitative polymerase chain reaction was used to test the mRNA expression level of the P2X7 receptor. Double-labeling immunofluorescence was used to identify the co-localization of the P2X7 receptor with glial fibrillary acidic protein (GFAP) in DRG. Molecular docking was performed to identify whether the Andro interacted perfectly with the rat P2X7 (rP2X7) receptor. Results: Andro attenuated the mechanical and thermal hyperalgesia in gp120+ddC-treated rats and down-regulated the P2X7 receptor mRNA and protein expression in the L4-L6 DRGs of gp120+ddC-treated rats. Additionally, Andro simultaneously decreased the expression of TNFα-R and IL-1β protein, increased the expression of IL-10 protein in L4-L6 DRGs, and inhibited the activation of ERK signaling pathways. Moreover, Andro decreased the co-expression of GFAP and the P2X7 receptor in the SGCs of L4-L6 DRG on 14th day after surgery. Conclusion: Andro decreased the hyperalgesia induced by gp120 plus ddC.
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Affiliation(s)
- Zhihua Yi
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
- Nursing College, Medical College of Nanchang University, Nanchang, China
- School of Life Sciences, Nanchang University, Nanchang, China
| | - Shuai Ouyang
- Undergraduate Student of the Clinical Department, Medical College of Nanchang University, Nanchang, China
| | - Congfa Zhou
- Department of Anatomy, Medical College of Nanchang University, Nanchang, China
| | - Lihui Xie
- Undergraduate Student of the Clinical Department, Medical College of Nanchang University, Nanchang, China
| | - Zhi Fang
- Undergraduate Student of the Clinical Department, Medical College of Nanchang University, Nanchang, China
| | - Huilong Yuan
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Jinpu Yang
- Undergraduate Student of the Queen Mary School, Medical College of Nanchang University, Nanchang, China
| | - Lifang Zou
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Tianyu Jia
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Shanhong Zhao
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Lin Li
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Liran Shi
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Yun Gao
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Guilin Li
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Shuangmei Liu
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Hong Xu
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Changshui Xu
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Chunping Zhang
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
- Department of Cell Biology, Medical College of Nanchang University, Nanchang, China
| | - Shangdong Liang
- Department of Physiology, Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
- School of Life Sciences, Nanchang University, Nanchang, China
- *Correspondence: Shangdong Liang,
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Abstract
PURPOSE OF REVIEW HIV-sensory neuropathy (HIV-SN) remains a common complication of HIV infection and may be associated with significant morbidity due to neuropathic pain. The overall purpose of this review is to discuss trends in the changing epidemiology in HIV-SN, new data regarding the pathophysiology of the condition, and discuss approaches to management. RECENT FINDINGS While HIV-SN has been historically considered the most common neurological complication of HIV infection, improved accessibility to effective combination antiretroviral therapy (cART), use of less neurotoxic antiretroviral medication regimens, and trends towards earlier introduction of treatment have impacted the condition: overall incident HIV-SN is likely decreased compared to prior rates and patients afflicted by HIV-SN may more frequently have asymptomatic or subclinical disease. Traditional predictors of HIV-SN have also changed, as traditional indices of severe immune deficiency such as low CD4 count and high viral load no longer predict HIV-SN. Emerging evidence supports the contention that both peripheral and central mechanisms underlying the generation as well as persistence of neuropathic pain in HIV-SN exist. It is important to recognize that even mild neuropathic pain in this clinical population is associated with meaningful impairment in quality of life and function, which emphasizes the clinical importance of recognizing and treating the condition. The general approach to management of neuropathic pain in HIV-SN is the introduction of symptomatic analgesic therapy. There exist, however, few evidence-based analgesic options for HIV-SN based on available clinical data. Symptomatic treatment trials are increasingly recognized to have been potentially confounded by more robust placebo response than that observed in other neuropathic pain conditions. In the authors' experience, use of analgesic therapies with proven efficacy in other neuropathic pain conditions is appropriate, bearing in consideration potential pharmacokinetic interactions with the cART regimen. Combination analgesic regimens may also achieve meaningful analgesic responses, particularly when drugs with differing mechanisms of action are utilized. It is paramount that the patient is appropriately counseled regarding expectations and the anticipated benefit of analgesic therapy, as pain relief is often incomplete but clinically meaningful improvement in pain and function can be achieved.
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Affiliation(s)
| | - Taylor B Harrison
- Department of Neurology, Emory University, Atlanta, GA, USA. .,Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, 80 Jesse Hill Jr., Drive Box 036, Atlanta, GA, 30303, USA.
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Abstract
Effective combination antiretroviral therapy has transformed HIV infection into a chronic disease, with HIV-infected individuals living longer and reaching older age. Neurological disease remains common in treated HIV, however, due in part to ongoing inflammation and immune activation that persist in chronic infection. In this review, we highlight recent developments in our understanding of several clinically relevant neurologic complications that can occur in HIV infection despite treatment, including HIV-associated neurocognitive disorders, symptomatic CSF escape, cerebrovascular disease, and peripheral neuropathy.
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Affiliation(s)
- Nisha S Bhatia
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Felicia C Chow
- Departments of Neurology and Medicine (Infectious Diseases), University of California, San Francisco, CA, USA
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Saylor D, Nakigozi G, Nakasujja N, Robertson K, Gray RH, Wawer MJ, Sacktor N. Peripheral neuropathy in HIV-infected and uninfected patients in Rakai, Uganda. Neurology 2017; 89:485-491. [PMID: 28679596 PMCID: PMC5539731 DOI: 10.1212/wnl.0000000000004136] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/11/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence, risk factors, and functional impairment associated with peripheral neuropathy in a prospective cohort of adults in rural Uganda. METHODS Eight hundred participants (400 HIV- and 400 antiretroviral-naive HIV+) in the Rakai Community Cohort Study underwent detailed neurologic evaluations including assessment of neuropathy symptoms, functional measures (Patient Assessment of Own Functioning Inventory and Karnofsky Performance Status scores), and neurologic evaluation by a trained medical officer. Neuropathy was defined as ≥1 subjective symptom and ≥1 sign of neuropathy on examination. Neuropathy risk factors were assessed using log binomial regression. RESULTS Fifty-three percent of participants were men, with a mean (SD) age of 35 (8) years. Neuropathy was present in 13% of the cohort and was more common in HIV+ vs HIV- participants (19% vs 7%, p < 0.001). Older age (relative risk [RR] 1.04, 95% confidence interval [CI] 1.02-1.06), female sex (RR 1.49, 95% CI 1.04-2.15), HIV infection (RR 2.82, 95% CI 1.86-4.28), tobacco use (RR 1.59, 95% CI 1.02-2.48), and prior neurotoxic medication use (RR 2.08, 95% CI 1.07-4.05) were significant predictors of neuropathy in the overall cohort. Only older age was associated with neuropathy risk in the HIV+ (RR 1.03, 95% CI 1.01-1.05) and HIV- (RR 1.06, 95% CI 1.02-1.10) cohorts. Neuropathy was associated with impaired functional status on multiple measures across all participant groups. CONCLUSIONS Peripheral neuropathy is relatively common and associated with impaired functional status among adults in rural Uganda. Older age, female sex, and HIV infection significantly increase the risk of neuropathy. Neuropathy may be an underrecognized but important condition in rural Uganda and warrants further study.
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Affiliation(s)
- Deanna Saylor
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Gertrude Nakigozi
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noeline Nakasujja
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kevin Robertson
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ronald H Gray
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria J Wawer
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ned Sacktor
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Benevides MLACDSE, Filho SB, Debona R, Bergamaschi ENC, Nunes JC. Prevalence of Peripheral Neuropathy and associated factors in HIV-infected patients. J Neurol Sci 2017; 375:316-320. [PMID: 28320159 DOI: 10.1016/j.jns.2017.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/13/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
The progress on HIV infection treatment has allowed a longer survival for HIV-infected patients. However, chronic comorbidities are emerging. Peripheral Neuropathy (PN) represents one of the most prevalent neurologic disorders among these patients, and comprehensive studies may contribute to a reduction in the morbidity of this condition. This is a cross-sectional analytic study conducted in a tertiary referral hospital in southern Brazil. This study investigates the prevalence of PN among HIV-infected patients and associated demographic, clinical and laboratory variables. A number of 150 HIV-infected patients admitted between January and May 2016 were interviewed, submitted to physical and neurological examination, and data from their medical records were obtained. The prevalence of PN was 31.3%. It was increased among older patients (p=0.02), patients with higher CD4 lymphocytes levels (p=0.02), and smokers (OR=3.4; 95% CI 1.6-6.9; p<0.01). The research identified a high prevalence of PN in HIV-infected patients. Older age and higher CD4 levels have been associated with PN. To the best of our knowledge, this was one of the first studies reporting an association between tobacco use and PN among HIV-infected patients. Further studies are necessary to elucidate the pathological mechanisms linking PN and tobacco.
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Affiliation(s)
| | - Sérgio Beduschi Filho
- Hospital Nereu Ramos (HNR), Rua Rui Barbosa, Agronômica, Florianópolis, Santa Catarina (SC), Brazil
| | - Rodrigo Debona
- Division of Neurology, UFSC, Rua Professora Maria Flora Pausewang, Trindade, Florianópolis, Brazil
| | | | - Jean Costa Nunes
- Division of Neuropathology, Universidade Federal de Santa Catarina (UFSC), Rua Professora Maria Flora Pausewang, Trindade, Florianópolis, Santa Catarina (SC), Brazil; Neurodiagnostic Brasil-Diagnósticos em Neuropatologia, Rua Santos Saraiva, Estreito, Florianópolis, Santa Catarina (SC), Brazil.
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Persistent Peripheral Nervous System Damage in Simian Immunodeficiency Virus-Infected Macaques Receiving Antiretroviral Therapy. J Neuropathol Exp Neurol 2016; 74:1053-60. [PMID: 26426267 DOI: 10.1097/nen.0000000000000249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Human immunodeficiency virus (HIV)-induced peripheral neuropathy is the most common neurologic complication associated with HIV infection. In addition to virus-mediated injury of the peripheral nervous system (PNS), treatment of HIV infection with combination antiretroviral therapy (cART) may induce toxic neuropathy as a side effect. Antiretroviral toxic neuropathy is clinically indistinguishable from the sensory neuropathy induced by HIV; in some patients, these 2 processes are likely superimposed. To study these intercurrent PNS disease processes, we first established a simian immunodeficiency virus (SIV)/pigtailed macaque model in which more than 90% of animals developed PNS changes closely resembling those seen in HIV-infected individuals with distal sensory neuropathy. To determine whether cART alters the progression of SIV-induced PNS damage, dorsal root ganglia and epidermal nerve fibers were evaluated in SIV-infected macaques after long-term suppressive cART. Although cART effectively suppressed SIV replication and reduced macrophage activation in the dorsal root ganglia, PGP 9.5 immunostaining and measurements of epidermal nerve fibers in the plantar surface of the feet of treated SIV-infected macaques clearly showed that cART did not normalize epidermal nerve fiber density. These findings illustrate that significant PNS damage persists in SIV-infected macaques on suppressive cART.
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Rhodes E, Andreae M, Bourgiose T, Indyk D, Rhodes R, Sacks H. Stakeholders' Views on Barriers to Research on Controversial Controlled Substances. THE JOURNAL OF CLINICAL ETHICS 2016; 27:308-321. [PMID: 28001138 PMCID: PMC5559713 DOI: 10.3109/15360288.2010.529988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many diseases and disease symptoms still lack effective treatment. At the same time, certain controversial Schedule I drugs, such as heroin and cannabis, have been reputed to have considerable therapeutic potential for addressing significant medical problems. Yet, there is a paucity of U.S. clinical studies on the therapeutic uses of controlled drugs. For example, people living with HIV/AIDS experience a variety of disease- and medication-related symptoms. Their chronic pain is intense, frequent, and difficult to treat. Nevertheless, clinical trials of compassionate management for their chronic symptoms, which should be a research priority, are stymied. We employed qualitative methods to develop an understanding of the barriers to research on potential therapeutic uses of Schedule I drugs so that they might be addressed. We elicited the perspectives of key stakeholder groups that would be involved in such studies: people living with HIV/AIDS, clinicians, and members of institutional review boards. As we identified obstacles to research, we found that all of the stakeholder groups arrived at the same conclusion, that clinical research on the therapeutic potential of these drugs is ethically required.
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Affiliation(s)
- Evelyn Rhodes
- Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, Box 1076, Annenberg 12-42, New York, New York 10029 USA.
| | - Michael Andreae
- Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St., Bronx, New York 10467 USA
| | | | - Debbie Indyk
- Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, Box 1076, Annenberg 12-42, New York, New York 10029 USA
| | - Rosamond Rhodes
- Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, Box 1076, Annenberg 12-42, New York, New York 10029 USA
| | - Henry Sacks
- Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, Box 1076, Annenberg 12-42, New York, New York 10029 USA
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Andreae MH, Rhodes E, Bourgoise T, Carter GM, White RS, Indyk D, Sacks H, Rhodes R. An Ethical Exploration of Barriers to Research on Controlled Drugs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:36-47. [PMID: 26982922 PMCID: PMC4849133 DOI: 10.1080/15265161.2016.1145282] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning.
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Steyl T, Shayo FT. The role of physiotherapy in the treatment of HIV-related sensory neuropathy: The perceptions and referral practices of physicians. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:286. [PMID: 30135881 PMCID: PMC6093136 DOI: 10.4102/sajp.v71i1.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/29/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND HIV-related peripheral neuropathies are among the most prevalent chronic neurological disorders affecting persons living with HIV and AIDS. In order to improve the physical function and quality of life of those affected by the disease, a holistic or multidisciplinary approach, including physiotherapy, has been suggested for the management of neuropathic pain. AIM The aim of this study was to explore the physicians' perceptions regarding the role of physiotherapy in the management of patients with HIV-sensory neuropathy (HIV-SN) and their referral practices in Tanzania. METHODS A qualitative study design incorporating purposive sampling was employed in the study. A total of 10 physicians from a hospital in Tanzania agreed to participate in in-depth interviews. RESULTS Physicians had poor perceptions of the role of physiotherapy in the management of patients with HIV-SN. Their inadequate knowledge of the role of physiotherapy and the limited number of physiotherapists employed negatively influenced their referral of patients with HIV-SN for physiotherapy. CONCLUSION In Tanzania, referral for physiotherapy is still dependent on medical doctors. Inter-professional learning is imperative for minimising the stereotypes that may exist across professions, hence the need to improve awareness of specific roles in patient management. This could improve knowledge of the role of other professionals in the management and rehabilitation of affected patients and consequently improve perceptions and facilitate referrals of patients with HIV-SN for more integrated care.
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Affiliation(s)
- Tania Steyl
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - Felista T. Shayo
- Department of Physiotherapy, University of the Western Cape, South Africa
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Mann R, Sadosky A, Schaefer C, Baik R, Parsons B, Nieshoff E, Stacey BR, Tuchman M, Nalamachu S. Burden of HIV-Related Neuropathic Pain in the United States. J Int Assoc Provid AIDS Care 2015; 15:114-25. [PMID: 26173942 DOI: 10.1177/2325957415592474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND HIV-related neuropathic pain (HIV-NeP) is common; however, the burden of HIV-NeP is not well-understood. METHODS The cross-sectional study aimed to characterize the HIV-NeP burden. A total of 103 patients with HIV-NeP recruited during routine office visits completed a questionnaire to assess patient-reported outcomes, including pain severity, health status, sleep, mood, and lost productivity. Physicians completed a 6-month retrospective chart review. RESULTS The sample was predominantly male and not employed for pay. A majority (75.7%) of patients experienced moderate or severe pain. Pain interference, general health, physical health, and depression were worse among patients with more severe pain (all Ps < .006). Most (87.4%) patients were prescribed at least 1 medication for NeP. HIV-related neuropathic pain was associated with 36.1% work impairment. Adjusted annualized costs increased with increasing pain severity (P < .0001). CONCLUSION The impact of HIV-NeP on health status, physical function, and depression increases with severity, resulting in substantial clinical and economic burden.
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Affiliation(s)
- Rachael Mann
- Covance Market Access Services Inc, San Diego, CA, USA
| | | | | | - Rebecca Baik
- Covance Market Access Services Inc, Gaithersburg, MD, USA
| | | | - Edward Nieshoff
- Rehabilitation Institute of Michigan/Wayne State University, Detroit, MI, USA
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Abstract
PURPOSE OF REVIEW To present an overview of HIV-associated distal symmetric polyneuropathy (HIV-DSP) and other HIV-related peripheral neuropathies in the post-highly active retroviral therapy era. RECENT FINDINGS HIV-DSP has become the most common neurologic complication of HIV largely due to the prolonged survival of HIV-positive patients with the advent of highly active retroviral therapy. HIV-DSP can be attributed to the disease itself or to secondary effects of certain HAART agents, and often the two disease entities cannot be distinguished. HIV-DSP can lead to significant morbidity and interfere with daily activities. Diagnosis can be obtained from a detailed history and neurologic exam revealing absent ankle jerks and abnormal, vibratory perception or decreased pinprick or temperature. Supporting studies include nerve conduction studies and skin biopsy. Although there are no United States Food and Drug Administration-approved treatments for HIV-DSP, clinicians often use off-label medications, including antidepressants, anticonvulsants, topical agents and other analgesics. SUMMARY The prevalence of those affected by HIV-DSP will continue to grow with the aging population of HIV-infected individuals. Compared to the diabetic neuropathy drug trials, trials in both symptomatic and disease-modifying agents for HIV-DSP have had little success. Other forms of HIV-related peripheral neuropathies are discussed briefly, and include acute and chronic inflammatory demyelinating polyneuropathy, autonomic neuropathy, polyradiculopathy, mononeuropathies, mononeuritis multiplex, cranial neuropathies, and amyotrophic lateral sclerosis-like motor neuropathy.
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Neuroinflammation and virus replication in the spinal cord of simian immunodeficiency virus-infected macaques. J Neuropathol Exp Neurol 2015; 74:38-47. [PMID: 25470348 DOI: 10.1097/nen.0000000000000148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Studies of neurologic diseases induced by simian immunodeficiency virus (SIV) in Asian macaques have contributed greatly to the current understanding of human immunodeficiency virus pathogenesis in the brain and peripheral nervous system. Detailed investigations into SIV-induced alterations in the spinal cord, a critical sensorimotor relay point between the brain and the peripheral nervous system, have yet to be reported. In this study, lumbar spinal cords from SIV-infected pigtailed macaques were examined to quantify SIV replication and associated neuroinflammation. In untreated SIV-infected animals, there was a strong correlation between amount of SIV RNA in the spinal cord and expression of the macrophage marker CD68 and the key proinflammatory mediators tumor necrosis factor and CCL2. We also found a significant correlation between SIV-induced alterations in the spinal cord and the degree of distal epidermal nerve fiber loss among untreated animals. Spinal cord changes (including elevated glial fibrillary acidic protein immunostaining and enhanced CCL2 gene expression) also were present in SIV-infected antiretroviral drug-treated animals despite SIV suppression. A fuller understanding of the complex virus and host factor dynamics in the spinal cord during human immunodeficiency virus infection will be critical in the development of new treatments for human immunodeficiency virus-associated sensory neuropathies and studies aimed at eradicating the virus from the central nervous system.
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Mangus LM, Dorsey JL, Laast VA, Ringkamp M, Ebenezer GJ, Hauer P, Mankowski JL. Unraveling the pathogenesis of HIV peripheral neuropathy: insights from a simian immunodeficiency virus macaque model. ILAR J 2015; 54:296-303. [PMID: 24615443 DOI: 10.1093/ilar/ilt047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Peripheral neuropathy (PN) is the most frequent neurologic complication in individuals infected with human immunodeficiency virus (HIV). It affects over one third of infected patients, including those receiving effective combination antiretroviral therapy. The pathogenesis of HIV-associated peripheral neuropathy (HIV-PN) remains poorly understood. Clinical studies are complicated because both HIV and antiretroviral treatment cause damage to the peripheral nervous system. To study HIV-induced peripheral nervous system (PNS) damage, a unique simian immunodeficiency virus (SIV)/pigtailed macaque model of HIV-PN that enabled detailed morphologic and functional evaluation of the somatosensory pathway throughout disease progression was developed. Studies in this model have demonstrated that SIV induces key pathologic features that closely resemble HIV-induced alterations, including inflammation and damage to the neuronal cell bodies in somatosensory ganglia and decreased epidermal nerve fiber density. Insights generated in the model include: finding that SIV alters the conduction properties of small, unmyelinated peripheral nerves; and that SIV impairs peripheral nerve regeneration. This review will highlight the major findings in the SIV-infected pigtailed macaque model of HIV-PN, and will illustrate the great value of a reliable large animal model to show the pathogenesis of this complex, HIV-induced disorder of the PNS.
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Afzal A, Benjamin M, Gummelt KL, Afzal S, Shamim S, Tribble M. Ascending paralysis associated with HIV infection. Proc AMIA Symp 2015; 28:25-8. [PMID: 25552790 PMCID: PMC4264702 DOI: 10.1080/08998280.2015.11929176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We present two patients with a high viral load of HIV-1 who developed symptoms of ascending paralysis leading to respiratory failure and autonomic instability. One patient had symptom improvement with highly active antiretroviral therapy (HAART) and a subsequent decrease in viral load. The other patient improved with intravenous immunoglobulin therapy and did not show much improvement on HAART alone. There are several proposed mechanisms for peripheral neuropathies seen in HIV-infected patients, including a direct action of HIV on the nerve by neurotropic strains or formation of autoantibodies against nerve elements. The comparison of the response to different therapies in these two cases highlights the importance of understanding different pathophysiologies, as the treatment modality may differ.
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Affiliation(s)
- Aasim Afzal
- Department of Internal Medicine (Afzal, Benjamin, Gummelt), the Division of Neurology (Shamim), and the Division of Infectious Diseases (Tribble), Baylor University Medical Center at Dallas
| | - Mina Benjamin
- Department of Internal Medicine (Afzal, Benjamin, Gummelt), the Division of Neurology (Shamim), and the Division of Infectious Diseases (Tribble), Baylor University Medical Center at Dallas
| | - Kyle L Gummelt
- Department of Internal Medicine (Afzal, Benjamin, Gummelt), the Division of Neurology (Shamim), and the Division of Infectious Diseases (Tribble), Baylor University Medical Center at Dallas
| | - Sadaf Afzal
- Department of Internal Medicine (Afzal, Benjamin, Gummelt), the Division of Neurology (Shamim), and the Division of Infectious Diseases (Tribble), Baylor University Medical Center at Dallas
| | - Sadat Shamim
- Department of Internal Medicine (Afzal, Benjamin, Gummelt), the Division of Neurology (Shamim), and the Division of Infectious Diseases (Tribble), Baylor University Medical Center at Dallas
| | - Marc Tribble
- Department of Internal Medicine (Afzal, Benjamin, Gummelt), the Division of Neurology (Shamim), and the Division of Infectious Diseases (Tribble), Baylor University Medical Center at Dallas
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Berth S, Caicedo HH, Sarma T, Morfini G, Brady ST. Internalization and axonal transport of the HIV glycoprotein gp120. ASN Neuro 2015; 7:1759091414568186. [PMID: 25636314 PMCID: PMC4720180 DOI: 10.1177/1759091414568186] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The HIV glycoprotein gp120, a neurotoxic HIV glycoprotein that is overproduced and shed by HIV-infected macrophages, is associated with neurological complications of HIV such as distal sensory polyneuropathy, but interactions of gp120 in the peripheral nervous system remain to be characterized. Here, we demonstrate internalization of extracellular gp120 in a manner partially independent of binding to its coreceptor CXCR4 by F11 neuroblastoma cells and cultured dorsal root ganglion neurons. Immunocytochemical and pharmacological experiments indicate that gp120 does not undergo trafficking through the endolysosomal pathway. Instead, gp120 is mainly internalized through lipid rafts in a cholesterol-dependent manner, with a minor fraction being internalized by fluid phase pinocytosis. Experiments using compartmentalized microfluidic chambers further indicate that, after internalization, endocytosed gp120 selectively undergoes retrograde but not anterograde axonal transport from axons to neuronal cell bodies. Collectively, these studies illuminate mechanisms of gp120 internalization and axonal transport in peripheral nervous system neurons, providing a novel framework for mechanisms for gp120 neurotoxicity.
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Affiliation(s)
- Sarah Berth
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, IL, USA
| | - Hector Hugo Caicedo
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, IL, USA
| | - Tulika Sarma
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, IL, USA
| | - Gerardo Morfini
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, IL, USA
| | - Scott T Brady
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, IL, USA
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Nasirinezhad F, Jergova S, Pearson JP, Sagen J. Attenuation of persistent pain-related behavior by fatty acid amide hydrolase (FAAH) inhibitors in a rat model of HIV sensory neuropathy. Neuropharmacology 2014; 95:100-9. [PMID: 25486617 DOI: 10.1016/j.neuropharm.2014.11.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 02/07/2023]
Abstract
Distal sensory neuropathies are a hallmark of HIV infections and can result in persistent and disabling pain despite advances in antiretroviral therapies. HIV-sensory neuropathic (HIV-SN) pain may be amenable to cannabinoid treatment, but currently available agonist treatments are limited by untoward side effects and potential for abuse in this patient population. Fatty acid amide hydrolase (FAAH) inhibitors may offer an alternative approach by inhibiting the degradation of endocannabinoids with purportedly fewer untoward CNS side effects. In order to evaluate this potential approach in the management of HIV-SN pain, the recombinant HIV envelope protein gp120 was applied epineurally to the rat sciatic nerve to induce an HIV-SN-like pain syndrome. Two distinct FAAH inhibitory compounds, URB597 and PF-3845 were tested, and contrasted with standard antinociceptive gabapentin or vehicle treatment, for attenuation of tactile allodynia, cold allodynia, and mechanical hyperalgesia. Both FAAH inhibitors markedly reduced cold and tactile allodynia with limited anti-hyperalgesic effects. Peak antinociceptive effects produced by both agents were more modest than gabapentin in reducing tactile allodynia with similar potency ranges. URB597 produced comparable cold anti-allodynic effects to gabapentin, and the effects of both FAAH inhibitors were longer lasting than gabapentin. To assess the contribution of cannabinoid receptors in these antinociceptive effects, CB1 antagonist AM251 or CB2 antagonist SR144528 were tested in conjunction with FAAH inhibitors. Results suggested a contribution of both CB1- and CB2-mediated effects, particularly in reducing tactile allodynia. In summary, these findings support inhibition of endocannabinoid degradation as a promising target for management of disabling persistent HIV-SN pain syndromes.
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Affiliation(s)
- Farinaz Nasirinezhad
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stanislava Jergova
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jacqueline Sagen
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
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Prevalence, incidence and predictors of peripheral neuropathy in African adults with HIV infection within the DART trial. AIDS 2014; 28:2579-88. [PMID: 25574960 DOI: 10.1097/qad.0000000000000447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated the prevalence, incidence and predictors of new peripheral neuropathy episodes in previously untreated, symptomatic HIV-infected Ugandan/Zimbabwean adults initiating zidovudine-based antiretroviral therapy (ART). DESIGN An open-label, multicentre, randomized trial. METHODS Peripheral neuropathy was self-reported at 12-weekly clinic visits. Cox regression models (excluding participants reporting preexisting peripheral neuropathy at ART initiation), considered sex; pre-ART WHO stage, age and CD4(+) cell count; CD4(+) cell count versus no CD4(+) cell count monitoring; and time-updated CD4(+) cell count, weight and use of stavudine, isoniazid and didanosine. RESULTS Four hundred and twenty-one out of 3316(13%) patients reported preexisting peripheral neuropathy at ART initiation. Median (interquartile range, IQR) follow-up in 2895 participants without preexisting peripheral neuropathy was 4.9 (4.7-5.4) years. Three hundred and fifty-four (12%) took stavudine as first-line substitution and 518 (18%) took isoniazid during follow-up. Two hundred and ninety (11%) participants developed a new peripheral neuropathy episode, an incidence of 2.12 per 100 person-years. Eighteen (0.1%) had a grade 3/4 episode. Independent predictors of peripheral neuropathy were current stavudine use [adjusted hazard ratio (a)HR 4.16 (95% confidence interval, 95% CI 3.06-5.66], current isoniazid use [aHR 1.59 (95% CI 1.02-2.47)] and current didanosine use [aHR 1.60 (95% CI 1.19-2.14)]. Higher risks were independently associated with higher pre-ART weight [aHR (per+5 kg) 1.07 (95% CI 1.01-1.13)] and older age aHR (per 10 years older) 1.29 (95% CI 1.12-1.49), but there was no significant effect of sex (P = 0.13), pre-ART CD4(+) cell count (P = 0.91) or CD4(+) cell count monitoring (P = 0.73). CONCLUSION Current stavudine, didanosine or isoniazid use continue to increase peripheral neuropathy risks, as does older age and weight at ART initiation; however, we found no evidence of increased risk in women in contrast to previous studies. The incidence of peripheral neuropathy may now be lower in ART programmes, as stavudine and didanosine are no longer recommended. All patients receiving isoniazid, either as part of antituberculosis (TB) chemotherapy or TB-preventive therapy, should receive pyridoxine as recommended in national guidelines.
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Xiao Y, Abrahamowicz M, Moodie EEM, Weber R, Young J. Flexible Marginal Structural Models for Estimating the Cumulative Effect of a Time-Dependent Treatment on the Hazard: Reassessing the Cardiovascular Risks of Didanosine Treatment in the Swiss HIV Cohort Study. J Am Stat Assoc 2014. [DOI: 10.1080/01621459.2013.872650] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Considerations About Risk Factors for Peripheral Neuropathies in Romanian HIV-Infected Patients. CURRENT HEALTH SCIENCES JOURNAL 2014; 40:42-6. [PMID: 24791204 PMCID: PMC4006335 DOI: 10.12865/chsj.40.01.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/01/2013] [Indexed: 11/23/2022]
Abstract
Purpose: The study aims at detecting risk factors for developing peripheral neuropathy in Romanian HIV infected subjects. Material/Methods: retrospective study (january 1990-january 2009) who analyzed data from patients hospitalized in the Regional Center Craiova. We have compared 26 patients (group N) diagnosed with peripheral neuropathy with 40 patients (group C) without neuropsychological sufferings, randomly selected. We have analysed: age, height, HIV mode of transmission, AIDS status, the average and nadir of CD4 lymphocytes, the mean viral load, the average duration of antiretroviral treatment (ART), use and duration of use of d-drugs, the presence of certain coinfection, diabetes or ethanol abuse. Results: the following differences were statistically significant: age (31,54±14,64 vs 23,9±12,03 years, p=0.024), HIV mode of transmission (parenteral/sexual: 13/13 vs 28/8, p = 0.044), the monitoring time duration (5,31±3,77 vs 7,75±5,4 years, p=0.043), median ART duration (37,2±9,66 vs 45,12±8,75 months, p=0.001). Close to the threshold of statistical significance are the CD4 nadir (97,33±65,6 vs 123,15±43,35 cells/mm3, p=0.058) and duration of use of d–drugs (22,5±31,94 vs 12,24±8,6 months, p=0.057). Odds ratio (OR) and relative risk (RR) increase with age. ROC analysis for the study group establishes a threshold difference of 29 years (sensitivity 50%, specificity 80%). Conclusions: higher age and advanced immunosupression are the most important risk factors for developing symptomatic peripheral neuropathy in Romanian HIV infected patients; taking into account the small number of cases studied, although not statistically significant, it should be noted the CD4 nadir and the length of d-drug use.
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Abstract
The use of animal models in the study of HIV and AIDS has advanced our understanding of the underlying pathophysiologic mechanisms of infection. Of the multitude of HIV disease manifestations, peripheral neuropathy remains one of the most common long-term side effects. Several of the most important causes of peripheral neuropathy in AIDS patients include direct association with HIV infection with or without antiretroviral medication and infection with opportunistic agents. Because the pathogeneses of these diseases are difficult to study in human patients, animal models have allowed for significant advancement in the understanding of the role of viral infection and the immune system in disease genesis. This review focuses on rodent, rabbit, feline and rhesus models used to study HIV-associated peripheral neuropathies, focusing specifically on sensory neuropathy and antiretroviral-associated neuropathies.
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Affiliation(s)
- Tricia H Burdo
- Department of Biology, Boston College, Chestnut Hill, MA, USA
| | - Andrew D Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Physical Therapy Interventions for Individuals with HIV Associated Distal Sensory Polyneuropathy: A Systematic Review. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432030-00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cettomai D, Kwasa JK, Birbeck GL, Price RW, Cohen CR, Bukusi EA, Kendi C, Meyer ACL. Screening for HIV-associated peripheral neuropathy in resource-limited settings. Muscle Nerve 2013; 48:516-24. [PMID: 24037693 DOI: 10.1002/mus.23795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Peripheral neuropathy is the most common neurological complication of human immunodeficiency virus (HIV) infection but is widely under-diagnosed in resource-limited settings. We investigated the utility of screening tools administered by nonphysician healthcare workers (HCW) and quantitative sensory testing (QST) administered by trained individuals for identification of moderate/severe neuropathy. METHODS We enrolled 240 HIV-infected outpatients using 2-stage cluster randomized sampling. HCWs administered the several screening tools. Trained study staff performed QST. Tools were validated against a clinical diagnosis of neuropathy. RESULTS Participants were 65% women, mean age 36.4 years, median CD4 324 cells/μL. A total of 65% were taking antiretrovirals, and 18% had moderate/severe neuropathy. The screening tests were 76% sensitive in diagnosing moderate/severe neuropathy with negative predictive values of 84-92%. QST was less sensitive but more specific. CONCLUSIONS Screening tests administered by HCW have excellent negative predictive values and are promising tools for scale-up in resource-limited settings. QST shows promise for research use.
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Affiliation(s)
- Deanna Cettomai
- Department of Neurology, University of California San Francisco, 1001 Potrero Avenue, 4M62, Box 0870, San Francisco, California, 94110, USA
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40
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Abstract
The neurological outcome of HIV infection has changed dramatically in the era of HAART. Despite effective suppression of plasma viral load and a substantial decrease in the incidence of HIV-associated dementia, neurocognitive impairment and peripheral neuropathy remain widespread. The neurotoxic side effects of antiretroviral (ARV) agents are among several contributing factors to this continued prevalence. Effective penetration of the CNS by ARV agents is paramount to treating neurological symptoms as well as systemic infection, but may also exacerbate the severity of drug-related neurotoxicity. The neurotoxic side effects of ARV agents vary widely between and within drug classes. The risks and benefits of combination regimens continue to evolve as more effective treatment protocols are developed.
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Affiliation(s)
- Charles T Upton
- University of North Carolina at Chapel Hill, Physicians Office Building 2195C, Chapel Hill, NC 27599, USA
| | - Babafemi Taiwo
- Northwestern University, 645 N Michigan Ave, Suite 900, Chicago, IL 60611, USA
| | - Kevin R Robertson
- University of North Carolina at Chapel Hill, Physicians Office Building 2127, Chapel Hill, NC 27599, USA
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41
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Lorber M. A Case of Possible Darunavir/Ritonavir-Induced Peripheral Neuropathy. ACTA ACUST UNITED AC 2013; 12:162-5. [DOI: 10.1177/2325957412471993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 65-year-old man, M.S.M., known as being HIV infected for 20 years, presented with muscle ache and progressive weakness 3 months after initiation of darunavir as a part of his antiretroviral therapy (ART). The patient's treatment included darunavir/ritonavir 600/100 mg twice daily, plus a backbone of didanosine and abacavir which were the backbone in his previous regimen for several years according to his drug resistance profile. Three months after initiation of darunavir/ritonavir the patient exhibited clinical symptoms of severe pain and progressive weakness of his lower limbs; he was unable to walk and was totally wheelchair-bound. Severe sensory peripheral polyneuropathy was revealed on electromyogram (EMG). All medications, including ART, were stopped. Within two months, concomitantly with initiation of raltegravir, etravirine and emcitricabine/tenofovir, the patient recovered, gained weight, resumed walking and his CD4 counts rose from 270 to 450 cells/mm3. A second EMG study 3 months after initiation of his new ART regimen showed compete recovery of the previously diagnosed peripheral neuropathy. In this report, we present a case of severe HIV-1-related acute demyelinating polyneuropathy which initiated after new generation PI darunavir/ritonavir was given and resolved after cessation of the drug without the use of immune-based therapies. The variety of HIV-related polyneuropathies will be discussed.
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Affiliation(s)
- Margalit Lorber
- Autoimmune Disease Unit, Rambam Medical Center, The Rapapport Faculty of Medicine, Haifa, Israel
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Domingo P, Cabeza MDC, Torres F, Salazar J, Gutierrez MDM, Mateo MG, Martínez E, Domingo JC, Fernandez I, Villarroya F, Ribera E, Vidal F, Baiget M. Association of thymidylate synthase polymorphisms with acute pancreatitis and/or peripheral neuropathy in HIV-infected patients on stavudine-based therapy. PLoS One 2013; 8:e57347. [PMID: 23468971 PMCID: PMC3585348 DOI: 10.1371/journal.pone.0057347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/21/2013] [Indexed: 12/22/2022] Open
Abstract
Background Low expression thymidylate synthase (TS) polymorphism has been associated with increased stavudine triphosphate intracellular (d4T-TP) levels and the lipodystrophy syndrome. The use of d4T has been associated with acute pancreatitis and peripheral neuropathy. However, no relationship has ever been proved between TS polymorphisms and pancreatitis and/or peripheral neuropathy. Methods We performed a case-control study to assess the relationship of TS and methylene-tetrahydrofolate reductase (MTHFR) gene polymorphisms with acute pancreatitis and/or peripheral neuropathy in patients exposed to d4T. Student’s t test, Pearson’s correlations, one-way ANOVA with Bonferroni correction and stepwise logistic regression analyses were done. Results Forty-three cases and 129 controls were studied. Eight patients (18.6%) had acute pancreatitis, and 35 (81.4%) had peripheral neuropathy. Prior AIDS was more frequent in cases than in controls (OR = 2.36; 95%CI 1.10–5.07, P = 0.0247). L7ow expression TS and MTHFR genotype associated with increased activity were more frequent in patients with acute pancreatitis and/or peripheral neuropathy than in controls (72.1% vs. 46.5%, OR = 2.97; 95%CI: 1.33–6.90, P = 0.0062, and 79.1% vs. 56.6%, OR = 2.90, 95%CI: 1.23–7.41, P = 0.0142, respectively). Independent positive or negative predictors for the development of d4T-associated pancreatitis and/or peripheral neuropathy were: combined TS and MTHFR genotypes (reference: A+A; P = 0.002; ORA+B = 0.34 [95%CI: 0.08 to 1.44], ORB+A = 3.38 [95%CI: 1.33 to 8.57], ORB+B = 1.13 [95%CI: 0.34 to 3.71]), nadir CD4 cell count >200 cells/mm3 (OR = 0.38; 95%CI: 0.17–0.86, P = 0.021), and HALS (OR = 0.39 95%CI: 0.18–0.85, P = 0.018). Conclusions Low expression TS plus a MTHFR genotype associated with increased activity is associated with the development of peripheral neuropathy in d4T-exposed patients.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Galantino ML, Belthoff C, Bessemer E, Carey W, Grow L, Homan G, Kietrys D. Screening Tools for Distal Sensory Polyneuropathy Associated with HIV Disease. REHABILITATION ONCOLOGY 2013. [DOI: 10.1097/01893697-201331030-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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