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Andalibi MS, Fields JA, Iudicello JE, Diaz MM, Tang B, Letendre SL, Ellis RJ. Elevated Biomarkers of Inflammation and Vascular Dysfunction Are Associated with Distal Sensory Polyneuropathy in People with HIV. Int J Mol Sci 2024; 25:4245. [PMID: 38673830 PMCID: PMC11049997 DOI: 10.3390/ijms25084245] [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: 01/22/2024] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Distal sensory polyneuropathy (DSP) is a disabling, chronic condition in people with HIV (PWH), even those with viral suppression of antiretroviral therapy (ART), and with a wide range of complications, such as reduced quality of life. Previous studies demonstrated that DSP is associated with inflammatory cytokines in PWH. Adhesion molecules, essential for normal vascular function, are perturbed in HIV and other conditions linked to DSP, but the link between adhesion molecules and DSP in PWH is unknown. This study aimed to determine whether DSP signs and symptoms were associated with a panel of plasma biomarkers of inflammation (d-dimer, sTNFRII, MCP-1, IL-6, IL-8, IP-10, sCD14) and vascular I integrity (ICAM-1, VCAM-1, uPAR, MMP-2, VEGF, uPAR, TIMP-1, TIMP-2) and differed between PWH and people without HIV (PWoH). A cross-sectional study was conducted among 143 participants (69 PWH and 74 PWoH) assessed by studies at the UC San Diego HIV Neurobehavioral Research Program. DSP signs and symptoms were clinically assessed for all participants. DSP was defined as two or more DSP signs: bilateral symmetrically reduced distal vibration, sharp sensation, and ankle reflexes. Participant-reported symptoms were neuropathic pain, paresthesias, and loss of sensation. Factor analyses reduced the dimensionality of the 15 biomarkers among all participants, yielding six factors. Logistic regression was used to assess the associations between biomarkers and DSP signs and symptoms, controlling for relevant demographic and clinical covariates. The 143 participants were 48.3% PWH, 47 (32.9%) women, and 47 (33.6%) Hispanics, with a mean age of 44.3 ± 12.9 years. Among PWH, the median (IQR) nadir and current CD4+ T-cells were 300 (178-448) and 643 (502-839), respectively. Participants with DSP were older but had similar distributions of gender and ethnicity to those without DSP. Multiple logistic regression showed that Factor 2 (sTNFRII and VCAM-1) and Factor 4 (MMP-2) were independently associated with DSP signs in both PWH and PWoH (OR [95% CI]: 5.45 [1.42-21.00], and 15.16 [1.07-215.22]), respectively. These findings suggest that inflammation and vascular integrity alterations may contribute to DSP pathogenesis in PWH, but not PWoH, possibly through endothelial dysfunction and axonal degeneration.
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Affiliation(s)
- Mohammadsobhan Sheikh Andalibi
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA;
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA; (J.A.F.); (J.E.I.)
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA 92093, USA
| | - Jerel Adam Fields
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA; (J.A.F.); (J.E.I.)
| | - Jennifer E. Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA; (J.A.F.); (J.E.I.)
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA 92093, USA
| | - Monica M. Diaz
- Department of Neurology, Multiple Sclerosis/Neuroimmunology Division, University of North Carolina at Chapel Hill School of Medicine, 170 Manning Drive, Campus Box 7025, Chapel Hill, NC 27599, USA;
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA; (J.A.F.); (J.E.I.)
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA; (J.A.F.); (J.E.I.)
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA;
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA; (J.A.F.); (J.E.I.)
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA 92093, USA
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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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3
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Ge S, Dune L, Liu M, Fu G, Ma H, Hu J, Lin X, Li J. Feasibility of therapeutic Chinese massage (tui na) for peripheral neuropathy among people with human immunodeficiency virus: findings of a pilot randomized controlled trial. Front Neurol 2023; 14:1148150. [PMID: 38107641 PMCID: PMC10722432 DOI: 10.3389/fneur.2023.1148150] [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: 01/19/2023] [Accepted: 10/25/2023] [Indexed: 12/19/2023] Open
Abstract
Background Peripheral neuropathy (PN) is prevalent in people with human immunodeficiency virus (PHIV) with no Food and Drug Administration-approved treatment. Therapeutic Chinese massage (TCM) is a promising noninvasive and non-harmful intervention for HIV-related PN. However, relevant research is lacking. The purpose of this study is to evaluate the feasibility of TCM for HIV-related PN. Method We conducted a pilot, single-centered, two-arm, double-blinded, randomized controlled trial. Twenty eligible PHIV were recruited primarily from the AIDS Foundation Houston, Inc. in Texas and were randomly assigned into two groups. Ten participants in the intervention group received three weekly 25-min TCM sessions by a certified TCM therapist. The remaining ten control group participants received the same therapist's three weekly 25-min placebo massage sessions on their lower extremities. The outcome was the feasibility of this study as measured by recruitment and completion rates, participant safety, and treatment adherence and compliance, as well as the effect size of the intervention. Results The study population comprised 20 PHIV (mean age 55.23). This study showed high feasibility as measured by a high rate of recruitment, a 100% rate of completion, and zero serious adverse events. As we inquired 21 respondents for eligibility for the study, all except one had HIV-related PN. All respondents were willing to participate in the study and adhered to the group assignment after they enrolled in the study. The participants' baseline pain was at a medium to a high level (6.30 [2.15] out of 10). Conclusion Chinese massage is a feasible intervention in PHIV. Future relevant randomized controlled trials are expected. Clinical trial registration https://clinicaltrials.gov/, NCT05379140.
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Affiliation(s)
- Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Linda Dune
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Guojing Fu
- Department of Tuina, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haixia Ma
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Jiale Hu
- Department of Nurse Anesthesia, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Xuechun Lin
- Hubei Key Laboratory of Food Nutrition and Safety, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Junxin Li
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
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Povshedna T, Swann SA, Levy SLA, Campbell AR, Choinière M, Durand M, Price C, Gill P, Murray MCM, Côté HCF. Global Prevalence of Chronic Pain in Women with HIV: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad350. [PMID: 37547855 PMCID: PMC10404009 DOI: 10.1093/ofid/ofad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023] Open
Abstract
Chronic pain is common among people with human immunodeficiency virus (HIV) and detrimental to quality of life and overall health. It is often underdiagnosed, undertreated, and frankly dismissed in women with HIV, despite growing evidence that it is highly prevalent in this population. Thus, we conducted a systematic review and meta-analysis to estimate the global prevalence of chronic pain in women with HIV. The full protocol can be found on PROSPERO (identifier CRD42022301145). Of the 2984 references identified in our search, 36 were included in the systematic review and 35 in the meta-analysis. The prevalence of chronic pain was 31.2% (95% confidence interval [CI], 24.6%-38.7%; I2 = 98% [95% CI, 97%-99%]; P < .0001). In this global assessment, we found a high prevalence of chronic pain among women with HIV, underscoring the importance of understanding the etiology of chronic pain, identifying effective treatments, and conducting regular assessments in clinical practice.
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Affiliation(s)
- Tetiana Povshedna
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shayda A Swann
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Sofia L A Levy
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amber R Campbell
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Madeleine Durand
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Colleen Price
- Canadian HIV/AIDS and Chronic Pain Society, Global Pain and HIV Task Force, Ottawa, Ontario, Canada
| | - Prubjot Gill
- Woodward Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
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5
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Rubinstein PG, Moore PC, Bimali M, Lee JY, Rudek MA, Chadburn A, Ratner L, Henry DH, Cesarman E, DeMarco CE, Costagliola D, Taoufik Y, Ramos JC, Sharon E, Reid EG, Ambinder RF, Mitsuyasu R, Mounier N, Besson C, Noy A. Brentuximab vedotin with AVD for stage II-IV HIV-related Hodgkin lymphoma (AMC 085): phase 2 results from an open-label, single arm, multicentre phase 1/2 trial. Lancet Haematol 2023; 10:e624-e632. [PMID: 37532416 PMCID: PMC10859222 DOI: 10.1016/s2352-3026(23)00157-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is approved in the upfront setting for advanced stage classical Hodgkin lymphoma (cHL). People living with HIV have been excluded from these studies. We aimed to understand the activity and safety of brentuximab vedotin-AVD in people living with HIV diagnosed with Hodgkin lymphoma, while focusing on HIV disease parameters and antiretroviral therapy (ART) interactions. METHODS We present the phase 2 portion of a multicentre phase 1/2 study. Eligible patients were 18 years or older, had untreated stage II-IV HIV-associated cHL (HIV-cHL), a Karnofsky performance status of more than 30%, a CD4+ T-cell count of 50 cells per μL or more, were required to take ART, and were not on strong CYP3A4 or P-glycoprotein inhibitors. Patients were treated intravenously with 1·2 mg/kg of brentuximab vedotin (recommended phase 2 dose) with standard doses of AVD for six cycles on days 1 and 15 of a 28-day cycle. The primary endpoint of the phase 2 portion was 2-year progression-free survival (PFS), assessed in all eligible participants who began treatment. Accrual has been completed. This trial is registered at ClinicalTrials.gov, NCT01771107. FINDINGS Between March 8, 2013, and March 7, 2019, 41 patients received study therapy with a median follow up of 29 months (IQR 16-38). 34 (83%) of 41 patients presented with stage III-IV and seven (17%) with stage II unfavourable HIV-cHL. 37 (90%) of 41 patients completed therapy, all 37 of whom achieved complete response. The 2-year PFS was 87% (95% CI 71-94) and the overall survival was 92% (78-97). The most common grade 3 or worse adverse events were peripheral sensory neuropathy (four [10%] of 41 patients), neutropenia (18 [44%]), and febrile neutropenia (five [12%]). One treatment-related death was reported, due to infection. INTERPRETATION Brentuximab vedotin-AVD was highly active and had a tolerable adverse event rate in HIV-cHL and is an important therapeutic option for people with HIV-cHL. The complete reponse rate is encouraging and is possibly related to a unique aspect of HIV-cHL biology. Upcoming 5-year data will evaluate the sustainability of the outcomes obtained. FUNDING National Institutes of Health and National Cancer Institute.
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Affiliation(s)
- Paul G Rubinstein
- John H Stroger Jr Hospital of Cook County (Cook County Hospital), Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA; Ruth M Rothstein CORE Center, Chicago, IL, USA; University of Illinois, Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA.
| | - Page C Moore
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Milan Bimali
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Amy Chadburn
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Lee Ratner
- Washington University School of Medicine, St Louis, MO, USA
| | - David H Henry
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Ethel Cesarman
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | | | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Yassine Taoufik
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicétre, France; Service d'imunologie biologique, Hôpitaux Paris Sud, AP-HP, Le Kremlin-Bicétrse, France
| | - Juan Carlos Ramos
- University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Erin G Reid
- Moores Cancer Center, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | | | - Ronald Mitsuyasu
- University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, CA, USA
| | | | - Caroline Besson
- CH Versailles, Le Chesnay, France; Inserm U1018, CESP, UVSQ, University Paris-Saclay, Villejuif, France
| | - Ariela Noy
- Weill Cornell Medical College, Cornell University, New York, NY, USA; Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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De León AM, Garcia-Santibanez R, Harrison TB. Article Topic: Neuropathies Due to Infections and Antimicrobial Treatments. Curr Treat Options Neurol 2023; 25:1-17. [PMID: 37360749 PMCID: PMC10256960 DOI: 10.1007/s11940-023-00756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/28/2023]
Abstract
Purpose of eview The aim of this review is to discuss the presentation, diagnosis, and management of polyneuropathy (PN) in selected infections. Overall, most infection related PNs are an indirect consequence of immune activation rather than a direct result of peripheral nerve infection, Schwann cell infection, or toxin production, though note this review will describe infections that cause PN through all these mechanisms. Rather than dividing them by each infectious agent separately, we have grouped the infectious neuropathies according to their presenting phenotype, to serve as a guide to clinicians. Finally, toxic neuropathies related to antimicrobials are briefly summarized. Recent findings While PN from many infections is decreasing, increasing evidence links infections to variants of GBS. Incidence of neuropathies secondary to use of HIV therapy has decreased over the last few years. Summary In this manuscript, a general overview of the more common infectious causes of PN will be discussed, dividing them across clinical phenotypes: large- and small-fiber polyneuropathy, Guillain-Barré syndrome (GBS), mononeuritis multiplex, and autonomic neuropathy. Rare but important infectious causes are also discussed.
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Affiliation(s)
- Andrés M. De León
- Neuromuscular Division Department of Neurology, Emory University, Executive Park 12 NE, GA 30329 Atlanta, USA
| | - Rocio Garcia-Santibanez
- Neuromuscular Division Department of Neurology, Emory University, Executive Park 12 NE, GA 30329 Atlanta, USA
| | - Taylor B. Harrison
- Division of Neuromuscular Medicine, Department of Neurology, Emory University School of Medicine, 83 Jessie Junior Drive Box 039, Atlanta, GA 30303 USA
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Zhu X, Ge S, Dune L, Yang C, Tian C, Wang Y. Tui Na for painful peripheral neuropathy in people with human immunodeficiency virus: A randomized, double-blind, placebo-controlled trial protocol. Front Neurol 2023; 14:1113834. [PMID: 36908633 PMCID: PMC9996030 DOI: 10.3389/fneur.2023.1113834] [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: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023] Open
Abstract
Background Peripheral neuropathy (PN), including numbness, loss of sensation, paresthesia, a burning sensation, and stabbing pain in extremities, is a common complication in people with human immunodeficiency virus (PHIV). Medications commonly used to treat HIV-related PN are not effective and lead to many side effects. HIV-related PN symptoms may be alleviated or treated with a series of therapeutic Chinese foot massages (TCFM), which are non-invasive and relatively safe. However, relevant studies are lacking. Study design This proposed trial is a prospective, two-arm, parallel, double-blinded, randomized controlled trial. Aim This proposed trial aims to assess the effectiveness of TCFM on HIV-related PN in people with HIV (PHIV). Outcomes The primary outcomes, measured at baseline, end of TCFM/placebo, and twelve weeks after, include (1), lower extremity pain, (2) lower extremity functioning, and (3) health-related quality of life. The secondary outcomes, measured throughout the trial process, include (1) recruitment and completion rate (No. of referred, No. of eligible, No. of enrolled, No. of withdrawals, trial recruitment rate, and trial completion rate), (2) participants' safety (No. and severity of adverse events), (3) treatment adherence (average time of each message session, No. of completed sessions, and No. of missed sessions), and (4) compliance (No. of participants completing the trial following the initial group assignment). Sample size An estimated 142 participants in total, or 71 participants in each arm, will be needed for this trial. Trial status This trial was registered at ClinicalTrials.gov of the National Institute of Health on Oct 26, 2022 (ClinicalTrials.gov Identifier: NCT05596123). The researchers expect to recruit participants starting in Feb. 2023 and ending in Feb 2025.
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Affiliation(s)
- Xingmei Zhu
- Yaxin School of Nursing, Wuhan Institute of Design and Science, Wuhan, Hubei, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Linda Dune
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chao Yang
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chong Tian
- School of Nursing, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Wang
- Department of Tuina, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Nikolaidis I, Karakasi MV, Bakirtzis C, Skoura L, Pilalas D, Boziki MK, Tsachouridou O, Voultsos P, Nikolaidis P, Gargalianos-Kakoliris P, Daniilidis M, Grigoriadis N, Metallidis S, Taskos N. Epidemiology of HIV-associated peripheral neuropathy in people living with human immunodeficiency virus infection in Greece. Int J STD AIDS 2022; 33:978-986. [PMID: 35975977 DOI: 10.1177/09564624221119305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral neuropathy is among the most common complications among people with HIV with prevalence rates varying widely among studies (10-58%). OBJECTIVE This study aims to assess the prevalence of HIV-associated peripheral neuropathy among HIV-positive people in Northern Greece monitored during the last 5-year period and investigate possible correlations with antiretroviral therapy, disease staging, and potential risk factors, as there is no prior epidemiological record in Greek patients. METHODS Four hundred twenty patients were divided into a group with peripheral neuropathy (n = 269), and those without (n = 151). Peripheral neuropathy was assessed with a validated Peripheral Neuropathy Screening tool. Statistical analyses were performed with SPSS, were two-tailed, and p-value was set at 0.05. RESULTS The incidence of peripheral neuropathy was estimated at 35.9%. Age was found to correlate with higher odds of developing HIV-peripheral neuropathy, rising by 4%/year. Females encountered 77% higher probability to develop peripheral neuropathy. Stage 3 of the disease associated with higher occurrence of peripheral neuropathy (96% as compared to stage-1 patients). Among patients with peripheral neuropathy, the duration of antiretroviral therapy was found to be longer than in those without. CONCLUSIONS Peripheral neuropathy remains one of the most common complications regardless of the antiretroviral-therapy type, indicating the involvement of other risk factors in its occurrence, such as the stage of the disease, age and gender. Therefore, the treating physician should screen patients as early and frequently as possible upon HIV-diagnosis to prevent the progression of this debilitating condition so that prolonged life-expectancy is accompanied by a good quality of life.
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Affiliation(s)
- Ioannis Nikolaidis
- Second Department of Neurology, AHEPA University General Hospital--Department of Neurosciences, Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Maria-Valeria Karakasi
- Third Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Christos Bakirtzis
- Second Department of Neurology, AHEPA University General Hospital--Department of Neurosciences, Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Lemonia Skoura
- First Department of Internal Medicine, AHEPA University General Hospital--Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Dimitrios Pilalas
- First Department of Internal Medicine, AHEPA University General Hospital--Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Marina-Kleopatra Boziki
- Second Department of Neurology, AHEPA University General Hospital--Department of Neurosciences, Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Olga Tsachouridou
- First Department of Internal Medicine, AHEPA University General Hospital--Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Polychronis Voultsos
- Bioethics, Department of Forensic Medicine and Toxicology, Aristotle University--Faculty of Medicine, Thessaloniki, Greece
| | - Pavlos Nikolaidis
- First Department of Internal Medicine, AHEPA University General Hospital--Aristotle University--School of Medicine, Thessaloniki, Greece
| | | | - Michail Daniilidis
- First Department of Internal Medicine, AHEPA University General Hospital--Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- Second Department of Neurology, AHEPA University General Hospital--Department of Neurosciences, Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Symeon Metallidis
- First Department of Internal Medicine, AHEPA University General Hospital--Aristotle University--School of Medicine, Thessaloniki, Greece
| | - Nikolaos Taskos
- Second Department of Neurology, AHEPA University General Hospital--Department of Neurosciences, Aristotle University--School of Medicine, Thessaloniki, Greece
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Abdo M, Wu X, Sharma A, Tassiopoulos KK, Brown TT, Koletar SL, Yin MT, Erlandson KM. Regional Differences in Risk of Recurrent Falls Among Older U.S. Women and Men with HIV in the HIV Infection, Aging, and Immune Function Long-Term Observational Study. AIDS Res Hum Retroviruses 2022; 38:530-537. [PMID: 35018800 PMCID: PMC9297325 DOI: 10.1089/aid.2021.0162] [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] [Indexed: 01/31/2023] Open
Abstract
Geographic location was a strong predictor of falls among women with and without HIV in the Women's Interagency HIV Study. We examined regional variation in falls in a more geographically diverse cohort of older people with HIV (PWH) and explored whether physical activity, sex, or body-mass index modified these associations. PWH enrolled in the A5322 HAILO (HIV Infection, Aging, and Immune Function Long-Term Observational Study). Participants who reported falls in the 6 months before each semiannual visit and had ≥1 consecutive pair of fall assessments were included. We examined associations of geographic region [Northeast, Midwest, South, and West] with recurrent falls (≥2) over each 12-month period using repeated measures multinomial logistic regression models and assessed effect modification by adding an interaction term between geographic region and each potential effect modifier. A total of 788 men and 192 women with median age of 51 years at study entry contributed up to 240 weeks of data. U.S. regions included Northeast (22%), Midwest (29%), South (20%), and West (28%). In multivariable analyses, compared with the Western region, greater risk was seen among Midwestern (odds ratio [OR] = 2.35 [95% confidence interval (CI) = 1.29-4.28]) and Southern regions (OR = 2.09 [95% CI = 1.09-4.01]). Among those with higher physical activity, the Midwestern region had higher odds of recurrent falls than the Western region. Among obese individuals, the Southern region had higher odds of recurrent falls than the Western region. Sex did not modify the association between region and recurrent falls. Among older PWH, fall risk varied by geographic region. Associations between geographic region and recurrent falls appeared to be modified by physical activity and obesity. This may help identify subgroups of older PWH for targeted fall screening/interventions.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Xingye Wu
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan L. Koletar
- Division of Infectious Diseases, Department of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Michael T. Yin
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, School of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
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10
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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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Mills AR, Nichols MA, Davenport E. Chronic pain and medical cannabis: Narrative review and practice considerations in persons living with HIV. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1584] [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)
- Alex R. Mills
- School of Pharmacy University of Mississippi Jackson Mississippi USA
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Alshammari NA, Alodhayani AA, Joy SS, Isnani A, Mujammami M, Alfadda AA, Siddiqui K. Evaluation of Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Type 2 Diabetic Patients with Longer Duration of Diabetes. Diabetes Metab Syndr Obes 2022; 15:3007-3014. [PMID: 36200063 PMCID: PMC9527617 DOI: 10.2147/dmso.s364933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neuropathy is the most common microvascular complications among diabetic patients. Diabetic peripheral neuropathy (DPN) is the predominant variety which may associate with increased in mortality and morbidity among type 2 diabetes mellitus (T2DM). OBJECTIVE To assess the prevalence of diabetic peripheral neuropathy and its correlation with risk factors among T2DM. METHODS This was a cross-sectional retrospective study, data was collected from a previous cohort study conducted at the University Diabetes Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia. The data of T2DM patients were collected from case report form, included demographic data, history of chronic diabetes neuropathy, and laboratory reports. Statistical analysis includes Student`s t test, chi square test, and Pearson correlation and logistic regression were performed. RESULTS A total of 430 patients with T2DM data was collected and analyzed, and of them 54% were females, with the mean age of 55.88 years. The prevalence of diabetic neuropathy among study participants were 40.2%, and 73.3% of them having the subtype polyneuropathy. The mean BMI; p = 0.006, FBS; p < 0.001, HbA1c; p < 0.001, cholesterol p = 0.001, LDL; p < 0.001, and triglyceride; p < 0.001 levels were a significantly higher among participants with diabetic neuropathy than without neuropathy. The male gender (Risk Ratio: 1.294, 95% CI:1.090, 1.536) p = 0.003, fasting blood glucose (Risk Ratio: 1.157, 95% CI:1.051, 1.273) p = 0.003 Cholesterol (Risk Ratio: 1.588, 95% CI:1.174, 2.147) p = 0.003, triglyceride (Risk Ratio: 1.290, 95% CI:1.086, 1.538), p = 0.004, and LDL (Risk Ratio: 1.299, 95% CI:1.073, 1.574), p = 0.007) were found to be significant risk factors for DPN. CONCLUSION DPN is highly prevalent among T2DM patients in Saudi Arabia. Poor glycemic control and hyperlipidemia were associated with significantly higher risk for DPN patients among T2DM.
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Affiliation(s)
- Nawaf A Alshammari
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- King Salman Specialist Hospital, Diabetes and Endocrine Center, Hail Health Cluster, Hail, Hail Region, Saudi Arabia
| | - Abdulaziz A Alodhayani
- Department of Family and Community Medicine College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salini S Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Arthur Isnani
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Assim A Alfadda
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia, Email
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Strength and endurance exercises on balance impairment, gait disturbance, and quality of life of persons living with HIV-related distal symmetrical polyneuropathy: A study protocol. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Abstract
PURPOSE OF REVIEW This article reviews the neurologic complications associated with human immunodeficiency virus (HIV) infection. RECENT FINDINGS Neurologic complications of HIV may be caused by direct virally mediated pathology, immune-mediated phenomena in response to viral infection, or opportunistic infections secondary to depletion of lymphocytes. These neurologic disorders may be influenced by the degree of immunosuppression (ie, CD4+ T-cell lymphocyte count) and stage of infection (early versus late), as well as use of antiretroviral therapy, and may manifest as a variety of central and peripheral neurologic syndromes, including the more commonly encountered HIV-associated cognitive disorders and length-dependent sensorimotor polyneuropathy, respectively. Immune dysregulation underlies the majority of these neurologic phenomena, as well as other HIV-associated conditions including immune reconstitution inflammatory syndrome (IRIS), CD8 lymphocytosis, and potentially the development of compartmentalized infection within the CSF, also referred to as CSF escape. SUMMARY This article reviews a spectrum of clinical syndromes and related neuropathologic states associated with HIV infection.
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15
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HIV Neuropathy-a Review of Mechanisms, Diagnosis, and Treatment of Pain. Curr Pain Headache Rep 2021; 25:55. [PMID: 34236528 DOI: 10.1007/s11916-021-00971-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This article is a systematic review of data from 2018 to 2020 regarding information from publications on epidemiologic, diagnostic, and therapeutic advancements in human immunodeficiency virus-associated peripheral neuropathy. RECENT FINDINGS The epidemiology/pathology of HIV neuropathy is discussed. Diagnostics includes skin wrinkling-eutectic mixture of local anesthetic test and neurologic examinations. Therapeutic interventions include pharmacologic and nonpharmacologic management as well as self-management strategies. Peripheral neuropathy continues to affect the lives of persons living with HIV. First-line treatment with pregabalin or gabapentin for HIV neuropathic pain has limited data on adequate response. Exercise and self-management strategies may provide benefit in pain reduction. Continuing research on risk factors and biomarkers for HIV-related peripheral neuropathy will be critical for future diagnostic and therapeutic agents.
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Bratt G, Brännström J, Missalidis C, Nyström T. Development of type 2 diabetes and insulin resistance in people with HIV infection: Prevalence, incidence and associated factors. PLoS One 2021; 16:e0254079. [PMID: 34191847 PMCID: PMC8244855 DOI: 10.1371/journal.pone.0254079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes and insulin resistance is an emerging issue in people with HIV. HIV-related mortality and morbidities have decreased markedly over the last few decades, while co-morbidities including type 2 diabetes (T2D) have increased. Setting This study investigated the incidence of T2D and insulin resistance in a cohort of HIV-patients on effective treatment. Methods Prevalence and baseline predictors of T2D were assessed in a cohort of 570 HIV-positive patients 50 years or older. Patients without diabetes (n = 505) were followed prospectively over a median period of 7.25 year (2012–2020) until T2D development, death or end of the study. T2D was defined as repeated fasting glucose values ≥7.0 mmol/L. Insulin resistance was defined as HOMA-IR ≥3.0. Predictors of T2D development (HIV-related parameters, lipids, hypertension, central obesity, inflammation, smoking and use of statins) were assessed using logistic regression analysis. Results 30% (153/505) had insulin resistance. During follow up (3485 patient-years) 9% (43/505) developed T2D and 7% (36/505) insulin resistance. Thus, at follow up the prevalence of either T2D or insulin resistance was 46% (232/505). T2D incidence was 1.2/100 patient-years. In multivariate analysis, after adjustment for age, T2D development was associated with baseline insulin resistance, hypertriglyceridemia, central obesity and statin treatment, but no HIV-related factors. Conclusion The incidence of T2D in this cohort of patients with well controlled HIV-infection was high. The predictive factors associated with the development of T2D were not unique for HIV positive patients. The findings underline the importance of lifestyle changes in avoidance of T2D in people with HIV.
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Affiliation(s)
- Göran Bratt
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
| | - Johanna Brännström
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Missalidis
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, South Hospital, Stockholm, Sweden
- * E-mail:
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17
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Abstract
The evolution of therapeutics for and management of human immunodeficiency virus-1 (HIV-1) infection has shifted it from predominately manifesting as a severe, acute disease with high mortality to a chronic, controlled infection with a near typical life expectancy. However, despite extensive use of highly active antiretroviral therapy, the prevalence of chronic widespread pain in people with HIV remains high even in those with a low viral load and high CD4 count. Chronic widespread pain is a common comorbidity of HIV infection and is associated with decreased quality of life and a high rate of disability. Chronic pain in people with HIV is multifactorial and influenced by HIV-induced peripheral neuropathy, drug-induced peripheral neuropathy, and chronic inflammation. The specific mechanisms underlying these three broad categories that contribute to chronic widespread pain are not well understood, hindering the development and application of pharmacological and nonpharmacological approaches to mitigate chronic widespread pain. The consequent insufficiencies in clinical approaches to alleviation of chronic pain in people with HIV contribute to an overreliance on opioids and alarming rise in active addiction and overdose. This article reviews the current understanding of the pathogenesis of chronic widespread pain in people with HIV and identifies potential biomarkers and therapeutic targets to mitigate it.
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Affiliation(s)
- Dylan R Addis
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer J DeBerry
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saurabh Aggarwal
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Gao N, Guo Y, Wang W. Acupuncture for HIV-associated distal symmetric peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25140. [PMID: 33725916 PMCID: PMC7969230 DOI: 10.1097/md.0000000000025140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated distal symmetric peripheral neuropathy (DSPN) is one of the most frequent neurological complications of HIV infection, and causes pain and dysaesthesias in millions globally. Many individuals with this infection report using acupuncture to manage their symptoms, but evidence supporting the use of acupuncture is limited. This systematic review will assess the effectiveness and safety of acupuncture for patients with HIV-associated DSPN. METHODS Databases including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Scopus, Web of science, AMED (Allied and Complementary Medicine), the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Database, VIP Database and clinical trials registers (the WHO International Clinical Trials Registry Platform portal and www.ClinicalTrials.gov) will be electronically searched from inception to December 1, 2020. All randomized controlled trials in English or Chinese without restriction on publication status will be included. Selection of studies, extraction of data, and assessment of studies quality will be independently performed by 2 reviewers. The primary outcome measure will be the change in pain intensity assessed by validated scales. Secondary outcomes include change in neurologic summary scores, quality of life, physical function evaluated by admitted tools, and adverse events related to acupuncture reported in the included trials. If possible, a meta-analysis will be conducted to provide an estimate of the pooled treatment effect using Review Manager 5.3 statistical software. Otherwise, qualitative descriptive analysis will be given. The results will be presented as the risk ratio for binary data and the mean difference (MD) or standardized MD for continuous data. RESULTS The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. CONCLUSION This review will be the first review entirely focused on assessing the effectiveness and safety of acupuncture for HIV-associated DSPN. PROSPERO REGISTRATION NUMBER CRD42020210994.
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19
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De Vincentis S, Tartaro G, Rochira V, Santi D. HIV and Sexual Dysfunction in Men. J Clin Med 2021; 10:jcm10051088. [PMID: 33807833 PMCID: PMC7961513 DOI: 10.3390/jcm10051088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Correspondence: ; Tel.: +39-059-396-2453; Fax: +39-059-396-1335
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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20
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Yuan NY, Kaul M. Beneficial and Adverse Effects of cART Affect Neurocognitive Function in HIV-1 Infection: Balancing Viral Suppression against Neuronal Stress and Injury. J Neuroimmune Pharmacol 2021; 16:90-112. [PMID: 31385157 PMCID: PMC7233291 DOI: 10.1007/s11481-019-09868-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) persist despite the successful introduction of combination antiretroviral therapy (cART). While insufficient concentration of certain antiretrovirals (ARV) may lead to incomplete viral suppression in the brain, many ARVs are found to cause neuropsychiatric adverse effects, indicating their penetration into the central nervous system (CNS). Several lines of evidence suggest shared critical roles of oxidative and endoplasmic reticulum stress, compromised neuronal energy homeostasis, and autophagy in the promotion of neuronal dysfunction associated with both HIV-1 infection and long-term cART or ARV use. As the lifespans of HIV patients are increased, unique challenges have surfaced. Longer lives convey prolonged exposure of the CNS to viral toxins, neurotoxic ARVs, polypharmacy with prescribed or illicit drug use, and age-related diseases. All of these factors can contribute to increased risks for the development of neuropsychiatric conditions and cognitive impairment, which can significantly impact patient well-being, cART adherence, and overall health outcome. Strategies to increase the penetration of cART into the brain to lower viral toxicity may detrimentally increase ARV neurotoxicity and neuropsychiatric adverse effects. As clinicians attempt to control peripheral viremia in an aging population of HIV-infected patients, they must navigate an increasingly complex myriad of comorbidities, pharmacogenetics, drug-drug interactions, and psychiatric and cognitive dysfunction. Here we review in comparison to the neuropathological effects of HIV-1 the available information on neuropsychiatric adverse effects and neurotoxicity of clinically used ARV and cART. It appears altogether that future cART aiming at controlling HIV-1 in the CNS and preventing HAND will require an intricate balancing act of suppressing viral replication while minimizing neurotoxicity, impairment of neurocognition, and neuropsychiatric adverse effects. Graphical abstract Schematic summary of the effects exerted on the brain and neurocognitive function by HIV-1 infection, comorbidities, psychostimulatory, illicit drugs, therapeutic drugs, such as antiretrovirals, the resulting polypharmacy and aging, as well as the potential interactions of all these factors.
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Affiliation(s)
- Nina Y Yuan
- School of Medicine, Division of Biomedical Sciences, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Marcus Kaul
- School of Medicine, Division of Biomedical Sciences, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA.
- Sanford Burnham Prebys Medical Discovery Institute, Infectious and Inflammatory Disease Center, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA.
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21
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Bush KM, Barber KR, Martinez JA, Tang SJ, Wairkar YP. Drosophila model of anti-retroviral therapy induced peripheral neuropathy and nociceptive hypersensitivity. Biol Open 2021; 10:bio.054635. [PMID: 33504470 PMCID: PMC7860131 DOI: 10.1242/bio.054635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The success of antiretroviral therapy (ART) has improved the survival of HIV-infected patients significantly. However, significant numbers of patients on ART whose HIV disease is well controlled show peripheral sensory neuropathy (PSN), suggesting that ART may cause PSN. Although the nucleoside reverse transcriptase inhibitors (NRTIs), one of the vital components of ART, are thought to contribute to PSN, the mechanisms underlying the PSN induced by NRTIs are unclear. In this study, we developed a Drosophila model of NRTI-induced PSN that recapitulates the salient features observed in patients undergoing ART: PSN and nociceptive hypersensitivity. Furthermore, our data demonstrate that pathways known to suppress PSN induced by chemotherapeutic drugs are ineffective in suppressing the PSN or nociception induced by NRTIs. Instead, we found that increased dynamics of a peripheral sensory neuron may possibly underlie NRTI-induced PSN and nociception. Our model provides a solid platform in which to investigate further mechanisms of ART-induced PSN and nociceptive hypersensitivity. This article has an associated First Person interview with the first author of the paper. Summary: Nucleoside reverse transcriptase inhibitors (NRTIs) that are important components of anti-retroviral therapies also cause peripheral sensory neuropathies (PSN). This article investigates ways in which NRTIs may cause PSN and outlines ways to better understand the mechanisms underlying it.
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Affiliation(s)
- Keegan M Bush
- Neuroscience Graduate Program, University of. Texas Medical Branch, Galveston, TX 77555, USA.,Mitchell Center for Neurodegenerative Diseases, Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Kara R Barber
- Neuroscience Graduate Program, University of. Texas Medical Branch, Galveston, TX 77555, USA.,Mitchell Center for Neurodegenerative Diseases, Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jade A Martinez
- Mitchell Center for Neurodegenerative Diseases, Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Shao-Jun Tang
- Neuroscience Graduate Program, University of. Texas Medical Branch, Galveston, TX 77555, USA .,Department of Neuroscience, Cell Biology, and Anatomy, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Yogesh P Wairkar
- Neuroscience Graduate Program, University of. Texas Medical Branch, Galveston, TX 77555, USA .,Mitchell Center for Neurodegenerative Diseases, Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Department of Neuroscience, Cell Biology, and Anatomy, University of Texas Medical Branch, Galveston, TX 77555, USA
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22
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Baker V, Nkhoma K, Trevelion R, Roach A, Winston A, Sabin C, Bristowe K, Harding R. “I have failed to separate my HIV from this pain”: the challenge of managing chronic pain among people with HIV. AIDS Care 2021:1-9. [PMID: 33443450 DOI: 10.1080/09540121.2020.1869148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pain is a highly prevalent and burdensome symptom among people with HIV (PWH). This study aims to identify how the experience of living with HIV and chronic pain influences pain beliefs, health-seeking and pain management. Thirty-nine purposively sampled PWH with chronic pain (sample characteristics = 61% women, 79% Black, Asian and minority ethnic groups, 18% men who have sex with men, 45-54 median age category) participated in focus groups in London. Focus groups were co-facilitated with community members. Transcripts wereanalysed using a thematic approach. Findings revealed that HIV stigma, fractured care pathways, and general practitioners' lack of HIV training are barriers to supported pain management. Unaddressed pain results in poorer mental health and reduced quality of life, which has important clinical implications for HIV treatment adherence. Creating HIV-specific pain resources, activating social networks, and pain self-management techniques are potential solutions. Person-centred assessment and HIV training is needed to help clinicians identify PWH with chronic pain. Clear guidelines need to be developed to identify which health service providers are responsible for chronic pain management in PWH. This study generated a refined version of the Fear Avoidance Model that introduces a dimension of HIV-specific behaviours that impact PWHs seeking chronic pain management.
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Affiliation(s)
- V. Baker
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - K. Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | | | - A. Roach
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - A. Winston
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, England
| | - C. Sabin
- Faculty of Population Health Sciences, Department of Infection & Population Health, University College London, London, England
| | - K. Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - R. Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
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23
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Julian T, Rekatsina M, Shafique F, Zis P. Human immunodeficiency virus-related peripheral neuropathy: A systematic review and meta-analysis. Eur J Neurol 2020; 28:1420-1431. [PMID: 33226721 DOI: 10.1111/ene.14656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Human immunodeficiency virus (HIV)-associated neurological syndromes occur in affected individuals as a consequence of primary HIV infection, opportunistic infections, inflammation and as an adverse effect of some forms of antiretroviral treatment (ART). The aim of this systematic review was to establish the epidemiological characteristics, clinical features, pathogenetic mechanisms and risk factors of HIV-related peripheral neuropathy (PN). METHODS A systematic, computer-based search was conducted using the PubMed database. Data regarding the above parameters were extracted. Ninety-four articles were included in this review. RESULTS The most commonly described clinical presentation of HIV neuropathy is the distal predominantly sensory polyneuropathy. The primary pathology in HIVPN appears to be axonal rather than demyelinating. Age and treatment with medications belonging in the nucleoside analogue reverse transcriptase class are risk factors for developing HIV-related neuropathy. The pooled prevalence of PN in patients naïve to ARTs was established to be 29% (95% CI: 9%-62%) and increased to 38% (95% confidence interval [CI]: 29%-48%) when looking into patients at various stages of their disease. More than half of patients with HIV-related neuropathy are symptomatic (53%, 95% CI: 41%-63%). Management of HIV-related neuropathy is mainly symptomatic, although there is evidence that discontinuation of some types of ART, such as didanosine, can improve or resolve symptoms. CONCLUSIONS Human immunodeficiency virus-related neuropathy is common and represents a significant burden in patients' lives. Our understanding of the disease has grown over the last years, but there are unexplored areas requiring further study.
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Affiliation(s)
- Thomas Julian
- Medical School, The University of Sheffield, Broomhall, Sheffield, UK.,Academic Directorate of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martina Rekatsina
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Faiza Shafique
- Academic Directorate of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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24
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Winias S, Radithia D, Savitri Ernawati D. Neuropathy complication of antiretroviral therapy in HIV/AIDS patients. Oral Dis 2020; 26 Suppl 1:149-152. [PMID: 32862548 DOI: 10.1111/odi.13398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Significant pain from HIV-associated sensory neuropathy (HIV-SN) affects 40% of HIV-infected individuals treated with antiretroviral therapy (ART). The most salient symptom of the neuropathy is pain, which frequently is moderate-to-severe intensity, associated with reduced activities and physical function, sleep disruption, increased severity of depression, and anxiety. Yet, evidence for managing painful HIV-SN is poor. The purpose of this study was to verify by scientific evidence the neuropathy complication in HIV/AIDS patients to develop effective pain management strategies. METHODS Design: Systematic review. DATA SOURCES PubMed (MEDLINE), Cochrane, www.controlled-trials.com. SELECTION CRITERIA the filter "English" was used, timeframed searched was 2009-2019, randomized controlled trials (RCT). Keywords were verified in MeSH "Peripheral Nervous System Disease" and "Antiretroviral Agents" or "Antiretroviral therapy." REVIEW METHOD the PRISMA flowchart was used. RESULT A systematic search following PRISMA guidelines was carried out, and 12 specific articles/studies on the subject were selected. The results revealed that HIV therapy, aging, body mass index, height, and systemic conditions influence neuropathy conditions in HIV/AIDS patients. The multistudies focused on pain management approaches such as administration of pain medication, drug combination to prevent side effects, or ART with minimal side effects. CONCLUSION Sensory neuropathy is a frequent complication of HIV infection and ART. An understanding of the mechanism and pathophysiology of neuropathy in HIV is urgently required to develop alternative treatment modalities and to evaluate preventive strategies.
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Affiliation(s)
- Saka Winias
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Desiana Radithia
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Diah Savitri Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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25
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Abstract
OBJECTIVE To investigate the prevalence of widespread pain among people with HIV (PWH) and describe associations with antiretroviral therapy (ART) and markers of HIV disease stage. DESIGN Cross-sectional analysis of cohort study in the United Kingdom and Ireland. METHODS Pain information was collected during the baseline visit (conducted from 2013 to 2015) through a self-completed manikin identifying pain at 15 sites from five body regions. Pain was classified as widespread if reported at at least four regions and at least seven sites, or regional otherwise. Chi-squared tests, Kruskal-Wallis tests and ordinal logistic regression were used to consider associations between pain extent and sociodemographic and HIV-related factors. RESULTS Among the 1207 participants (614 PWH ≥ 50 years, 330 PWH < 50 years, 263 HIV-negative controls ≥50 years), pain was most commonly reported at the upper (left: 28.9%, right: 28.0%) and lower (left: 25.7%; right: 24.5%) leg, upper (18.6%) and lower (29.7%) back and shoulders (left: 16.0%; right: 16.8%). Widespread pain was more commonly reported in PWH than in HIV-negative controls (PWH ≥ 50 years: 18.7%; PWH < 50 years: 12.7%; HIV-negative ≥50 years: 9.5%) with regional pain reported in 47.6, 44.8 and 49.8%, respectively (global P = 0.001). In multivariable analyses, pain extent was greater in those with lower educational attainment, those exposed to more ART drugs, and those with a higher current CD4 cell count but longer exposure to immunosuppression. CONCLUSION Widespread pain is commonly reported in PWH and is associated with longer duration of exposure to HIV, immunosuppression and ART. Our findings call for greater awareness, and interventions to support the management, of pain in PWH.
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26
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Kallianpur AR, Wen W, Erwin AL, Clifford DB, Hulgan T, Robbins GK. Higher iron stores and the HFE 187C>G variant delay onset of peripheral neuropathy during combination antiretroviral therapy. PLoS One 2020; 15:e0239758. [PMID: 33057367 PMCID: PMC7561201 DOI: 10.1371/journal.pone.0239758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/13/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE People with HIV (PWH) continue to experience sensory neuropathy and neuropathic pain in the combination antiretroviral therapy (cART) era for unclear reasons. This study evaluated the role of iron in a previously reported association of iron-loading hemochromatosis (HFE) gene variants with reduced risk of neuropathy in PWH who received more neurotoxic cART, since an iron-related mechanism also might be relevant to neuropathic symptoms in PWH living in low-resource settings today. DESIGN This time-to-event analysis addressed the impact of systemic iron levels on the rapidity of neuropathy onset in PWH who initiated cART. METHODS Soluble transferrin receptor (sTFR), the sTFR-ferritin index of iron stores, and high-sensitivity C-reactive protein (hsCRP) levels were determined in stored baseline sera from participants of known HFE genotype from AIDS Clinical Trials Group (ACTG) Study 384, a multicenter randomized clinical trial that evaluated cART strategies. Associations with incident neuropathy were evaluated in proportional-hazards, time-to-event regression models, adjusting for potential confounders. RESULTS Of 151 eligible participants with stored serum who were included in the original genetic study, 43 had cART-associated neuropathy; 108 had sufficient serum for analysis, including 30 neuropathy cases. Carriers of HFE variants had higher systemic iron (lower sTFR and sTFR-ferritin index) and lower hsCRP levels than non-carriers (all p<0.05). Higher sTFR or iron stores, the HFE 187C>G variant, and lower baseline hsCRP were associated with significantly delayed neuropathy in self-reported whites (n = 28; all p-values<0.05), independent of age, CD4+ T-cell count, plasma HIV RNA, and cART regimen. CONCLUSIONS Higher iron stores, the HFE 187C>G variant, and lower hsCRP predicted delayed onset of neuropathy among self-reported white individuals initating cART. These findings require confirmation but may have implications for cART in HIV+ populations in areas with high endemic iron deficiency, especially those PWH in whom older, more neurotoxic antiretroviral drugs are occasionally still used.
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Affiliation(s)
- Asha R. Kallianpur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail:
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Angelika L. Erwin
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, Ohio, United States of America
| | - David B. Clifford
- Division of Infectious Diseases, Departments of Medicine and Neurology, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Todd Hulgan
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Gregory K. Robbins
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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27
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Mukoma JN, Matheri JM, Tawa N. Prevalence and clinical characteristics associated with peripheral neuropathy amongst persons on HAART in Busia County, Kenya. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1430. [PMID: 32935068 PMCID: PMC7479421 DOI: 10.4102/sajp.v76i1.1430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite improved immunological and viral load control, the prevalence of HIV/AIDS-related peripheral neuropathy among survivors on highly active antiretroviral therapy (HAART) is rising globally raising public health concerns. Objectives To determine the prevalence and clinical characteristics of peripheral neuropathy amongst persons on HAART attending Comprehensive Care Clinics in Busia County, Kenya. Method This cross-sectional descriptive quantitative study utilised purposive sampling and included 289 adults living with HIV/AIDS. Data collection was undertaken using the Clinical HIV Associated Neuropathy Tool (CHANT) and analysed using the Statistical Package for the Social Sciences version 25.0. Results Of people on HAART, 68.17% (197 amongst 289) had peripheral neuropathy. The majority were female 76.8% (n = 222), 38.1% (n = 110) were between 41 and 50, and 35% (n = 101) were widowed. The most common primary symptom was reduced right foot big toe vibration (76.8%, n = 222). There was a strong positive relationship (r = 0.621, P = 0.000) between foot vibration and illness. There was a statistically significant influence of demographic characteristics of persons on HAART on PN as they accounted for 98.5% of the variance (R2 = 0.985). Conclusion Peripheral neuropathy is prevalent and is significantly influenced by socio-demographic characteristics of persons on HAART-PN. Early diagnosis and exercise guidance by physiotherapists is key in forestalling severe symptoms, disability and poor quality of life. Clinical implications There is need to screen persons living with HIV on HAART for PN to establish their medical, physiotherapy and rehabilitation needs. Early diagnosis will encourage healthcare workers to start interventions to prevent progression of impairment, onset of disability and decrease in quality of life. Therefore, adaptation of PN screening tools and physiotherapeutic interventions should be considered.
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Affiliation(s)
- John N Mukoma
- Department of Physiotherapy, Busia County Referral Hospital, Busia, Kenya
| | - Joseph M Matheri
- Department of Physiotherapy, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nassib Tawa
- Department of Physiotherapy, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,The Center for Research in Spinal Health & Rehabilitation Medicine, Nairobi, Kenya
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28
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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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29
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Chisati EM, Munthali F, Constantinou D, Lampiao F. Physical activity levels among Malawian adults living with HIV and receiving anti-retroviral therapy. Malawi Med J 2020; 32:8-12. [PMID: 32733653 PMCID: PMC7366159 DOI: 10.4314/mmj.v32i1.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Despite increasing life expectancy among people living with HIV (PLWHIV), anti-retroviral therapy (ART) side effects, HIV chronic inflammation and co-morbidities may limit functional abilities and reduced participation in exercises and physical activity (PA). PA improves wellbeing and overall quality of life of PLWHIV. In Malawi, there is paucity of information regarding PA levels among Malawians living with HIV and receiving ART. Therefore, this study aimed at determining PA levels among PLWHIV and receiving ART in Malawi. Methods A quantitative cross-sectional design was employed. Eligible participants were male and female adults aged 18–45 years living with HIV receiving ART for at least 1 year. The participants were recruited from Limbe Health Center, Gateway Health Center and Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. The International Physical Activity Questionnaire (IPAQ) was used to assess the PA levels. A Stadiometer (HS-DBS00361, Model: 1127154) was used to measure weight (kg) and height (cm) of the participants. Results A total of 213 participants were recruited. There were more females than male participants (n=132 females). Overall, the mean age of all participants was 37±6.5 years and they were within normal body weight (BMI=23±4.0). Many participants (n=85, 40%) had low PA levels followed by those who were moderately physically active (n=75, 36%). A larger proportion of the female participants (51%) had low PA levels compared to males (22%). Forty-two percent of participants with 1–3 years of ART had low PA whereas 39% with >3 years ART had low PA. Conclusion Most PLWHIV and receiving ART in the sample have low PA levels. The study has also revealed that proportionally more females than males had low PA levels.
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Affiliation(s)
- Enock M Chisati
- Department of Physiotherapy, College of Medicine, University of Malawi, Blantyre, Malawi.,Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
| | | | - Demitri Constantinou
- Center for Exercise Science and Sports Medicine, FIMS Collaborating Center of Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Fanuel Lampiao
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi.,Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM)
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30
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Ellis RJ, Diaz M, Sacktor N, Marra C, Collier AC, Clifford DB, Calcutt N, Fields JA, Heaton RK, Letendre SL. Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV. Ann Clin Transl Neurol 2020; 7:1166-1173. [PMID: 32619341 PMCID: PMC7359117 DOI: 10.1002/acn3.51097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. METHODS Ambulatory, community-dwelling HIV seropositive individuals were recruited at six research centers. Clinical evaluations at baseline and 12 years later determined neuropathy signs and distal neuropathic pain (DNP). Additional assessments measured activities of daily living and quality of life (QOL). Factors potentially associated with DSP and DNP progression included disease severity, treatment, demographics, and co-morbidities. Adjusted odds ratios were calculated for follow-up neuropathy outcomes. RESULTS Of 254 participants, 21.3% were women, 57.5% were non-white. Mean baseline age was 43.5 years. Polyneuropathy prevalence increased from 25.7% to 43.7%. Of 173 participants initially pain-free, 42 (24.3%) had incident neuropathic pain. Baseline risk factors for incident pain included unemployment (OR [95% CI], 5.86 [1.97, 17.4]) and higher baseline body mass index (BMI) (1.78 [1.03, 3.19] per 10-units). Participants with neuropathic pain at follow-up had significantly worse QOL and greater dependence in activities of daily living than those who remained pain-free. INTERPRETATION HIV DSP and neuropathic pain increased in prevalence and severity over 12 years despite high rates of viral suppression. The high burden of neuropathy included disability and poor life quality. However, substantial numbers remained pain-free despite clear evidence of neuropathy on exam. Protective factors included being employed and having a lower BMI. Implications for clinical practice include promotion of lifestyle changes affecting reversible risk factors.
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Affiliation(s)
- Ronald J. Ellis
- Departments of Neurosciences and PsychiatryUniversity of California, San DiegoLa JollaCalifornia
| | - Monica Diaz
- Department of MedicineUniversity of California, San DiegoLa JollaCalifornia
| | - Ned Sacktor
- Department of NeurologyJohns Hopkins UniversityBaltimoreMaryland
| | - Christina Marra
- Department of NeurologyUniversity of WashingtonSeattleWashington
| | - Ann C. Collier
- Department of MedicineUniversity of WashingtonSeattleWashington
| | | | - Nigel Calcutt
- Department of PathologyUniversity of California, San DiegoLa JollaCalifornia
| | - Jerel A. Fields
- Department of PsychiatryUniversity of California, San DiegoLa JollaCalifornia
| | - Robert K. Heaton
- Department of PsychiatryUniversity of California, San DiegoLa JollaCalifornia
| | - Scott L. Letendre
- Departments of Medicine and PsychiatryUniversity of California, San DiegoLa JollaCalifornia
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31
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Vecchio AC, Marra CM, Schouten J, Jiang H, Kumwenda J, Supparatpinyo K, Hakim J, Sacktor N, Campbell TB, Tripathy S, Kumarasamy N, La Rosa A, Santos B, Silva MT, Kanyama C, Firnhaber C, Hosseinipour MC, Mngqibisa R, Hall C, Cinque P, Robertson K. Distal Sensory Peripheral Neuropathy in Human Immunodeficiency Virus Type 1-Positive Individuals Before and After Antiretroviral Therapy Initiation in Diverse Resource-Limited Settings. Clin Infect Dis 2020; 71:158-165. [PMID: 31630166 PMCID: PMC7312215 DOI: 10.1093/cid/ciz745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/03/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Distal sensory peripheral neuropathy (DSPN) is a complication of human immunodeficiency virus (HIV). We estimate DSPN prevalence in 7 resource-limited settings (RLSs) for combination antiretroviral therapy (cART)-naive people living with HIV (PLWH) compared with matched participants not living with HIV and in PLWH virally suppressed on 1 of 3 cART regimens. METHODS PLWH with a CD4+ count <300 cells/mm3 underwent standardized neurological examination and functional status assessments before and every 24 weeks after starting cART. Matched individuals not living with HIV underwent the same examinations once.Associations between covariates with DSPN at entry were assessed using the χ2 test, and virally suppressed PLWH were assessed using generalized estimating equations. RESULTS Before initiating cART, 21.3% of PLWH had DSPN compared with 8.5% of people not living with HIV (n = 2400; χ2(df = 1) = 96.5; P < .00001). PLWH with DSPN were more likely to report inability to work [χ2(df = 1) = 10.6; P = .001] and depression [χ2(df = 1) = 8.9; P = .003] than PLWH without DSPN. Overall prevalence of DSPN among those virally suppressed on cART decreased: 20.3%, week 48; 15.3%, week 144; and 10.3%, week 192. Incident DSPN was seen in 127 PLWH. Longitudinally, DSPN was more likely in older individuals (P < .001) and PLWH with less education (P = .03). There was no significant association between cART regimen and DSPN. CONCLUSIONS Although the prevalence of DSPN decreased following cART initiation in PLWH, further research could identify strategies to prevent or ameliorate residual DSPN after initiating cART in RLSs.
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Affiliation(s)
- Alyssa C Vecchio
- Neurological HIV Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christina M Marra
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jeffrey Schouten
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington, USA
| | - Hongyu Jiang
- Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnstone Kumwenda
- Queen Elizabeth College of Medicine-Johns Hopkins Project, Blantyre, Malawi
| | | | - James Hakim
- Department of Neurology, University of Zimbabwe, Harare, Zimbabwe
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas B Campbell
- Department of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | | | | | | | - Cindy Firnhaber
- Department of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rosie Mngqibisa
- Durban International Clinical Research Site, Durban, South Africa
| | - Colin Hall
- Neurological HIV Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paola Cinque
- Neurovirology Unit, Universita Vita – Salute San Raffaele, Milan, Italy
| | - Kevin Robertson
- Neurological HIV Center, University of North Carolina, Chapel Hill, North Carolina, USA
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32
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Keltner JR, Tong A, Visser E, Jenkinson M, Connolly CG, Dasca A, Sheringov A, Calvo Z, Umbao E, Mande R, Bilder MB, Sahota G, Franklin DR, Corkran S, Grant I, Archibald S, Vaida F, Brown GG, Atkinson JH, Simmons AN, Ellis RJ. Evidence for a novel subcortical mechanism for posterior cingulate cortex atrophy in HIV peripheral neuropathy. J Neurovirol 2020; 26:530-543. [PMID: 32524422 DOI: 10.1007/s13365-020-00850-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/10/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022]
Abstract
We previously reported that neuropathic pain was associated with smaller posterior cingulate cortical (PCC) volumes, suggesting that a smaller/dysfunctional PCC may contribute to development of pain via impaired mind wandering. A gap in our previous report was lack of evidence for a mechanism for the genesis of PCC atrophy in HIV peripheral neuropathy. Here we investigate if volumetric differences in the subcortex for those with neuropathic paresthesia may contribute to smaller PCC volumes, potentially through deafferentation of ascending white matter tracts resulting from peripheral nerve damage in HIV neuropathy. Since neuropathic pain and paresthesia are highly correlated, statistical decomposition was used to separate pain and paresthesia symptoms to determine which regions of brain atrophy are associated with both pain and paresthesia and which are associated separately with pain or paresthesia. HIV+ individuals (N = 233) with and without paresthesia in a multisite study underwent structural brain magnetic resonance imaging. Voxel-based morphometry and a segmentation/registration tool were used to investigate regional brain volume changes associated with paresthesia. Analysis of decomposed variables found that smaller midbrain and thalamus volumes were associated with paresthesia rather than pain. However, atrophy in the PCC was related to both pain and paresthesia. Peak thalamic atrophy (p = 0.004; MNI x = - 14, y = - 24, z = - 2) for more severe paresthesia was in a region with reciprocal connections with the PCC. This provides initial evidence that smaller PCC volumes in HIV peripheral neuropathy are related to ascending white matter deafferentation caused by small fiber damage observed in HIV peripheral neuropathy.
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Affiliation(s)
- John R Keltner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA. .,VA San Diego Healthcare System, San Diego, CA, USA. .,UCSD Department of Psychiatry, UCSD HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B, Mailcode 8231, San Diego, CA, 92103-8231, USA.
| | - Alan Tong
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Eelke Visser
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England
| | - Colm G Connolly
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Alyssa Dasca
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Aleks Sheringov
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Zachary Calvo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Earl Umbao
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Rohit Mande
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mary Beth Bilder
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Gagandeep Sahota
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Stephanie Corkran
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sarah Archibald
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Florin Vaida
- Department of Family and Preventative Medicine, University of California San Diego, San Diego, CA, USA
| | - Gregory G Brown
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - J Hampton Atkinson
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, CA, USA
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Biology of the human blood-nerve barrier in health and disease. Exp Neurol 2020; 328:113272. [PMID: 32142802 DOI: 10.1016/j.expneurol.2020.113272] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
A highly regulated endoneurial microenvironment is required for normal axonal function in peripheral nerves and nerve roots, which structurally consist of an outer collagenous epineurium, inner perineurium consisting of multiple concentric layers of specialized epithelioid myofibroblasts that surround the innermost endoneurium, which consists of myelinated and unmyelinated axons embedded in a looser mesh of collagen fibers. Endoneurial homeostasis is achieved by tight junction-forming endoneurial microvessels that control ion, solute, water, nutrient, macromolecule and leukocyte influx and efflux between the bloodstream and endoneurium, and the innermost layers of the perineurium that control interstitial fluid component flux between the freely permeable epineurium and endoneurium. Strictly speaking, endoneurial microvascular endothelium should be considered the blood-nerve barrier (BNB) due to direct communication with circulating blood. The mammalian BNB is considered the second most restrictive vascular system after the blood-brain barrier (BBB) based on classic in situ permeability studies. Structural alterations in endoneurial microvessels or interactions with hematogenous leukocytes have been described in several human peripheral neuropathies; however major advances in BNB biology in health and disease have been limited over the past 50 years. Guided by transcriptome and proteome studies of normal and pathologic human peripheral nerves, purified primary and immortalized human endoneurial endothelial cells that form the BNB and leukocytes from patients with well-characterized peripheral neuropathies, validated by in situ or ex vivo protein expression studies, data are emerging on the molecular and functional characteristics of the human BNB in health and in specific peripheral neuropathies, as well as chronic neuropathic pain. These early advancements have the potential to not only increase our understanding of how the BNB works and adapts or fails to adapt to varying insult, but provide insights relevant to pathogenic leukocyte trafficking, with translational potential and specific therapeutic application for chronic peripheral neuropathies and neuropathic pain.
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Pillay P, Wadley AL, Cherry CL, Karstaedt AS, Kamerman PR. Clinical diagnosis of sensory neuropathy in HIV patients treated with tenofovir: A 6-month follow-up study. J Peripher Nerv Syst 2019; 24:304-313. [PMID: 31587421 DOI: 10.1111/jns.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sensory neuropathy (SN) is a common and often painful neurological condition associated with HIV-infection and its treatment. However, data on the incidence of SN in neuropathy-free individuals initiating combination antiretroviral therapies (cART) that do not contain the neurotoxic agent stavudine are lacking. AIMS We investigated the 6-month incidence of SN in ART naïve individuals initiating tenofovir (TDF)-based cART, and the clinical factors associated with the development of SN. METHODS 120 neuropathy-free and ART naïve individuals initiating cART at a single center in Johannesburg, South Africa were enrolled. Participants were screened for SN using clinical signs and symptoms at study enrolment and approximately every 2-months for a period of ~6-months. Diagnostic criteria for symptomatic SN was defined by the presence of at least one symptom (pain/burning, numbness, paraesthesias) and at least two clinical signs (reduced vibration sense, absent ankle reflexes or pin-prick hypoaesthesia). Diagnostic criteria for asymptomatic SN required at least two clinical signs only (as above). RESULTS A total of 88% of the cohort completed three visits within the 6-month period. The 6-month cumulative incidence of neuropathy was 140 cases per 1000 patients (95% CI: 80-210) at an incidence rate of 0.37 (95% CI: 0.2-0.5) per person year. Height and active tuberculosis (TB) disease were independently associated with the risk of developing SN (P < .05). INTERPRETATION We found that within the first 6 months of starting cART, incident SN persists in the post-stavudine era, with 11 (9%) of individuals developing asymptomatic SN, and 9 (8%) developing symptomatic SN.
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Affiliation(s)
- Prinisha Pillay
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine L Cherry
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Alan S Karstaedt
- Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Peter R Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
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Tumusiime DK, Stewart A, Venter FWD, Musenge E. The effects of a physiotherapist-led exercise intervention on peripheral neuropathy among people living with HIV on antiretroviral therapy in Kigali, Rwanda. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1328. [PMID: 31535052 PMCID: PMC6739563 DOI: 10.4102/sajp.v75i1.1328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022] Open
Abstract
Background HIV-associated peripheral neuropathy (PN) is common in people living with HIV. Its management is mostly symptomatic utilising pharmacological approaches. Objectives This study determined the effects of an exercise intervention on PN among Rwandan people living with HIV receiving antiretroviral therapy (ART). Methods A 12-week single-blinded randomised controlled trial using the Brief Peripheral Neuropathy Screen (BPNS) as the assessment tool tested the effects of an exercise intervention on PN, followed by a 12-week non-intervention period. A total of 120 people with HIV- associated PN on ART were randomised to an exercise or no exercise group. Both groups continued receiving routine care. A bivariate analysis using Pearson’s chi-square test for significant differences in PN symptoms and signs, between groups, at baseline, after the 12 weeks intervention and 12 weeks post-intervention using generalised linear regression models to determine predictors of treatment outcomes was undertaken, utilising an intention-to-treat analysis (alpha p ≤ 0.05). Results At 12 weeks, the intervention group compared to the control: neuropathic pain 70% versus 94% (p < 0.005), PN symptoms severity – mild and/or none in 85% versus 60% (p < 0.001) and radiation of PN symptoms reduced, 80% versus 37% (p < 0.001). There were no differences in PN signs at 12 weeks intervention and at 12 weeks post-intervention. Having changed the antiretroviral (ARV) and having developed PN symptoms after the start on ARVs predicted treatment improvement, while demographic factors did not predict any treatment outcome. Conclusion A physiotherapist-led exercise intervention improved PN symptoms, but with non-significant improvement in PN signs. Factors related to early diagnosis and treatment of PN were facilitators for the improvement of PN symptoms. Clinical implications Physiotherapist-led exercises should be integrated into the routine management of people living with HIV on ART with PN symptoms.
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Affiliation(s)
- David K Tumusiime
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aimée Stewart
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois W D Venter
- Witwatersrand Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa.,Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Biostatistics and Epidemiology, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Dudley MT, Borkum M, Basera W, Wearne N, Heckmann JM. Peripheral neuropathy in HIV patients on antiretroviral therapy: Does it impact function? J Neurol Sci 2019; 406:116451. [PMID: 31521960 DOI: 10.1016/j.jns.2019.116451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022]
Abstract
HIV-associated distal sensory polyneuropathy (DSP), with or without neuropathic symptoms, can develop after anti-retroviral therapy (ART). Symptoms frequently involve small fibres but reports on autonomic dysfunction in HIV-DSP are sparse. We studied an HIV-infected cohort after 5 years of ART, and report on the frequency and severity of autonomic symptoms and the impact of DSP on everyday function. This cross-sectional study comprised of participants from a community-based South African HIV-clinic. The Brief Peripheral Neuropathy Screen and reduced Total Neuropathy Score evaluated neuropathic symptoms/signs. DSP was defined as ≥2 symmetrical DSP-signs, and symptomatic DSP when accompanied by neuropathic symptoms. Autonomic symptoms questionnaires, heart rate variability and postural blood pressure changes were assessed. The Lower Extremity Functional Scale (LEFS) was completed. The 67 participants had a median age of 42 years and median ART exposure of 7 years with viral suppression in 84%. Most (81%) met our criteria for DSP and 36% had additional neuropathic symptoms. Autonomic symptoms and signs (above normative values) were present in 15% and more likely in those with symptomatic DSP (P < .001). Participants with DSP, even without symptoms, had lower LEFS scores (P ≤ .039) than those without. HIV-DSP is prevalent and impacts on daily living.
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Affiliation(s)
- Meagan T Dudley
- Department of Medicine, University of Cape Town, South Africa
| | - Megan Borkum
- Division of Nephrology, Department of Medicine, University of Cape Town, South Africa
| | - Wisdom Basera
- Department of Medicine, University of Cape Town, South Africa
| | - Nicola Wearne
- Division of Nephrology, Department of Medicine, University of Cape Town, South Africa
| | - Jeannine M Heckmann
- Division of Neurology, Department of Medicine, University of Cape Town, South Africa.
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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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Gaff J, Octaviana F, Ariyanto I, Cherry C, Laws SM, Price P. Polymorphisms in CAMKK2 associate with susceptibility to sensory neuropathy in HIV patients treated without stavudine. J Neurovirol 2019; 25:814-824. [PMID: 31309408 DOI: 10.1007/s13365-019-00771-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/14/2019] [Accepted: 06/03/2019] [Indexed: 01/20/2023]
Abstract
HIV-associated sensory neuropathy (HIV-SN) is a debilitating neurological complication of HIV infection potentiated by the antiretroviral drug stavudine. While stavudine is no longer used, HIV-SN now affects around 15% of HIV+ Indonesians. Here, we investigate whether polymorphisms within the P2X-block (P2X4R, P2X7R, CAMKK2) and/or ANAPC5 mark susceptibility to HIV-SN in this setting. As polymorphisms in these genes associated with HIV-SN in African HIV patients receiving stavudine, the comparison can identify mechanisms independent of stavudine. HIV patients who had never used stavudine (n = 202) attending clinics in Jakarta were screened for neuropathy using the AIDS Clinical Trials Group Brief Peripheral Neuropathy Screen. Open-array technology was used to type 48 polymorphisms spanning the four genes. Haplotypes were derived for each gene using fastPHASE. Haplogroups were constructed with median-joining methods. Multivariable models optimally predicting HIV-SN were based on factors achieving p < 0.2 in bivariate analyses. Minor alleles of three co-inherited polymorphisms in CAMKK2 (rs7975295*C, rs1560568*A, rs1132780*T) associated with a reduced prevalence of HIV-SN individually and after adjusting for lower CD4 T cell count and viremia (p = 0.0002, pseudo R2 = 0.11). The optimal model for haplotypes linked HIV-SN with viremia and lower current CD4 T cell count, plus CAMKK2 haplotypes 6 and 11 and P2X7R haplotypes 2 and 12 (p = 0.0002; pseudo R2 = 0.11). CAMKK2 haplogroup A (includes 16 haplotypes and all instances of rs7975295*C, rs1560568*A, rs1132780*T) associated with reduced rates of HIV-SN (p = 0.02, OR = 0.43 CI = 0.21-0.88). These findings support a protective role for these three alleles, suggesting a role in the pathogenesis of HIV-SN that is independent of stavudine.
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Affiliation(s)
- Jessica Gaff
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
| | - Fitri Octaviana
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Neurology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ibnu Ariyanto
- Virology and Cancer Pathobiology Research Center, Universitas Indonesia, Jakarta, Indonesia
| | - Catherine Cherry
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Simon M Laws
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia.,Collaborative Genomics Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Patricia Price
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia. .,Virology and Cancer Pathobiology Research Center, Universitas Indonesia, Jakarta, Indonesia. .,School of Physiology, University of Witwatersrand, Johannesburg, South Africa.
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Antiallodynic Effects of Cannabinoid Receptor 2 (CB 2R) Agonists on Retrovirus Infection-Induced Neuropathic Pain. Pain Res Manag 2019; 2019:1260353. [PMID: 31354896 PMCID: PMC6637694 DOI: 10.1155/2019/1260353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
The most common neurological complication in patients receiving successful combination antiretroviral therapy (cART) is peripheral neuropathic pain. Data show that distal symmetric polyneuropathy (DSP) also develops along with murine acquired immunodeficiency syndrome (MAIDS) after infection with the LP-BM5 murine retrovirus mixture. Links between cannabinoid receptor 2 (CB2R) and peripheral neuropathy have been established in animal models using nerve transection, chemotherapy-induced pain, and various other stimuli. Diverse types of neuropathic pain respond differently to standard drug intervention, and little is currently known regarding the effects of modulation through CB2Rs. In this study, we evaluated whether treatment with the exogenous synthetic CB2R agonists JWH015, JWH133, Gp1a, and HU308 controls neuropathic pain and neuroinflammation in animals with chronic retroviral infection. Hind-paw mechanical hypersensitivity in CB2R agonist-treated versus untreated animals was assessed using the MouseMet electronic von Frey system. Multicolor flow cytometry was used to determine the effects of CB2R agonists on macrophage activation and T-lymphocyte infiltration into dorsal root ganglia (DRG) and lumbar spinal cord (LSC). Results demonstrated that, following weekly intraperitoneal injections starting at 5 wk p.i., JWH015, JWH133, and Gp1a, but not HU308 (5 mg/kg), significantly ameliorated allodynia when assessed 2 h after ligand injection. However, these same agonists (2x/wk) did not display antiallodynic effects when mechanical sensitivity was assessed 24 h after ligand injection. Infection-induced macrophage activation and T-cell infiltration into the DRG and LSC were observed at 12 wk p.i., but this neuroinflammation was not affected by treatment with any CB2R agonist. Activation of JAK/STAT3 has been shown to contribute to development of neuropathic pain in the LSC and pretreatment of primary murine microglia (2 h) with JWH015-, JWH133-, or Gp1a-blocked IFN-gamma-induced phosphorylation of STAT1 and STAT3. Taken together, these data show that CB2R agonists demonstrate acute, but not long-term, antiallodynic effects on retrovirus infection-induced neuropathic pain.
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41
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Sakabumi DZ, Moore RC, Tang B, Delaney PA, Keltner JR, Ellis RJ. Chronic Distal Sensory Polyneuropathy Is a Major Contributor to Balance Disturbances in Persons Living With HIV. J Acquir Immune Defic Syndr 2019; 80:568-573. [PMID: 30649035 PMCID: PMC6482029 DOI: 10.1097/qai.0000000000001953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medical comorbidities accumulate in older persons living with HIV (PLWH), causing disability and reduced quality of life. Sensory neuropathy and polypharmacy may contribute to balance difficulties and falls. The contribution of neuropathy is understudied. OBJECTIVE To evaluate the contribution of chronic distal sensory polyneuropathy (cDSPN) to balance disturbances among PLWH. METHODS Ambulatory PLWH and HIV- adults (N = 3379) were prospectively studied. All participants underwent a neurologic examination to document objective abnormality diagnostic of cDSPN and reported neuropathy symptoms including pain, paresthesias, and numbness. Participants provided detailed information regarding balance disturbance and falls over the previous 10 years. Balance disturbances were coded as minimal or none and mild-to-moderate. Covariates included age, HIV disease, and treatment characteristics and medications (sedatives, opioids, and antihypertensives). RESULTS Eleven percent of participants reported balance disturbances at some time during the last 10 years; the rate in PLWH participants exceeding that for HIV- [odds ratio 2.59, 95% confidence interval: 1.85 to 3.64]. Fifty-two percent met criteria for cDSPN. Balance problems were more common in those with cDSPN [odds ratio = 3.3 (2.6-4.3)]. Adjusting for relevant covariates, balance disturbances attributable to cDSPN were more frequent among HIV+ than HIV- (interaction P = 0.001). Among individuals with cDSPN, older participants were much more likely to report balance disturbances than younger ones. CONCLUSIONS cDSPN contributes to balance problems in PLWH. Assessments of cDSPN in older PLWH should be a clinical priority to identify those at risk and to aid in fall prevention and the ensuing consequences, including bone fractures, subdural hematoma, hospital admissions, and fatal injury.
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Affiliation(s)
- Duaa Z. Sakabumi
- Health Sciences International, University of California, San Diego, 8950 La Jolla Village Dr, San Diego, CA 92037, USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - Bin Tang
- HIV Neurobehavioral Research Centre, 220 Dickinson St, San Diego, CA 92103, USA
| | - Patrick A. Delaney
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - John R. Keltner
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
- HIV Neurobehavioral Research Centre, 220 Dickinson St, San Diego, CA 92103, USA
| | - Ronald J. Ellis
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
- Department of Neurosciences, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
- HIV Neurobehavioral Research Centre, 220 Dickinson St, San Diego, CA 92103, USA
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Nkhoma K, Ahmed A, Alli Z, Sherr L, Harding R. Is symptom prevalence and burden associated with HIV treatment status and disease stage among adult HIV outpatients in Kenya? A cross-sectional self-report study. AIDS Care 2019; 31:1461-1470. [PMID: 30913897 DOI: 10.1080/09540121.2019.1595514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
People with HIV experience a high prevalence and burden of physical and psychological symptoms throughout their disease trajectory. These have important public and clinical health implications. We aimed to measure: the seven-day period prevalence of symptoms, the most burdensome symptoms, and determine if self-reported symptom burden is associated with treatment status, clinical stage and physical performance. We conducted a cross-sectional study among adult (aged at least 18 years) patients with HIV, attending HIV outpatient care in Kenya. Data was gathered through self-report using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), file extraction (sociodemographic data, treatment status, CD4 count, clinical stage) and through observation using the Karnofsky Performance Scale (KPS). Multivariable ordinal logistic regression assessed the association of symptom burden (MSAS-SF) controlling for demographic and clinical variables. Of the 475 participants approached, 400 (84.2%) participated. Ordinal logistic regression showed that being on HIV treatment was associated lower global distress index (in quartiles) (odds ratio .45, 95% CI .23 to .88; p = 0.019). Pain and symptom burden still persist in the era of antiretroviral therapy. Routine clinical practice should incorporate assessment and management of pain and symptoms irrespective of disease stage and treatment status in order to achieve the proposed fourth "90" in the UNAIDS 90-90-90 targets (that is good quality of life).
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Affiliation(s)
- Kennedy Nkhoma
- Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation , London , UK
| | | | - Zipporah Alli
- Kenya Hospices and Palliative Care Association , Nairobi , Kenya
| | - Lorraine Sherr
- Institute for Global Health, University College London , London , UK
| | - Richard Harding
- Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation , London , UK
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Epidemiology and factors associated with peripheral neuropathy among HIV infected patients in Gondar, Ethiopia: A cross-sectional study. PLoS One 2019; 14:e0211354. [PMID: 30695060 PMCID: PMC6350981 DOI: 10.1371/journal.pone.0211354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/13/2019] [Indexed: 01/23/2023] Open
Abstract
Background Antiretroviral therapy has surely increased the life expectancy of people living with HIV. However, long term complications like HIV associated sensory neuropathy has a negative impact on quality of life among people living with HIV (PLHIV). In Ethiopia, lack of data on magnitude of the burden and predictors of HIV associated sensory neuropathy in many resource limited setting has led to under diagnosis and eventually under management of HIV-SN. Hence, this study was set out to establish the burden of HIV-associated sensory neuropathy and, its association with demographic, health and clinical characteristics among people living with HIV in Ethiopia. Methods Cross-sectional study was conducted to assess the prevalence of HIV-associated sensory neuropathy and the associated factors among adult HIV patients at University of Gondar Teaching Hospital, Gondar, Ethiopia. Brief Peripheral Neuropathy Screening tool validated by AIDs Clinical trial group was used for screening HIV-associated sensory neuropathy. Data were analyzed descriptively and through uni- and multivariate logistic regression. Results In total 359 adult PLHIV with a mean age of 36.5± 9.07 years participated, their median duration of HIV infection was 60 months (IQR 36–84) and their median CD4 count 143cells/μL (IQR 69.5–201.5). Age above 40 years, anti-tuberculosis regimen, tallness, and exposure to didanosine contained antiretroviral therapy were found to be associated with HIV-associated sensory neuropathy (AOR 1.82, 1.84, 1.98 and 4.33 respectively). Conclusions More than half of the HIV patients who attended HIV care clinic at University of Gondar hospital during the study period were found to present with peripheral sensory neuropathy. Higher age, tallness, TB medication, and didanosine in ART were significantly associated with HIV-SN as screened by effective diagnostic (BPNS) tool.
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Wireless Physical Activity Monitor Use Among Adults Living With HIV: A Scoping Review. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Asahchop EL, Branton WG, Krishnan A, Chen PA, Yang D, Kong L, Zochodne DW, Brew BJ, Gill MJ, Power C. HIV-associated sensory polyneuropathy and neuronal injury are associated with miRNA-455-3p induction. JCI Insight 2018; 3:122450. [PMID: 30518697 DOI: 10.1172/jci.insight.122450] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022] Open
Abstract
Symptomatic distal sensory polyneuropathy (sDSP) is common and debilitating in people with HIV/AIDS, leading to neuropathic pain, although the condition's cause is unknown. To investigate biomarkers and associated pathogenic mechanisms for sDSP, we examined plasma miRNA profiles in HIV/AIDS patients with sDSP or without sDSP in 2 independent cohorts together with assessing related pathogenic effects. Several miRNAs were found to be increased in the Discovery Cohort (sDSP, n = 29; non-DSP, n = 40) by array analyses and were increased in patients with sDSP compared with patients without sDSP. miR-455-3p displayed a 12-fold median increase in the sDSP group, which was confirmed by machine learning analyses and verified by reverse transcription PCR. In the Validation Cohort (sDSP n = 16, non-DSP n = 20, healthy controls n = 15), significant upregulation of miR-455-3p was also observed in the sDSP group. Bioinformatics revealed that miR-455-3p targeted multiple host genes implicated in peripheral nerve maintenance, including nerve growth factor (NGF) and related genes. Transfection of cultured human dorsal root ganglia with miR-455-3p showed a concentration-dependent reduction in neuronal β-III tubulin expression. Human neurons transfected with miR-455-3p demonstrated reduced neurite outgrowth and NGF expression that was reversed by anti-miR-455-3p antagomir cotreatment. miR-455-3p represents a potential biomarker for HIV-associated sDSP and might also exert pathogenic effects leading to sDSP.
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Affiliation(s)
- Eugene L Asahchop
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - William G Branton
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Anand Krishnan
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Patricia A Chen
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Dong Yang
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Linglong Kong
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas W Zochodne
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce J Brew
- Departments of Neurology and HIV, St. Vincent's Hospital, and Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Power
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Detectable Plasma HIV RNA Is Associated With Sensory Neuropathy in Patients With HIV Treated Without Stavudine. J Acquir Immune Defic Syndr 2018; 79:e108-e110. [DOI: 10.1097/qai.0000000000001836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pain in people living with HIV and its association with healthcare resource use, well being and functional status. AIDS 2018; 32:2697-2706. [PMID: 30289809 DOI: 10.1097/qad.0000000000002021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We describe the prevalence of pain and its associations with healthcare resource utilization and quality-of-life. DESIGN The POPPY Study recruited three cohorts: older people living with HIV (PLWH; ≥50 years, n = 699), younger demographically/lifestyle similar PLWH (less than 50 years, n = 374) and older demographically/lifestyle similar HIV-negative (≥50 years, n = 304) people from April 2013 to February 2016. METHODS Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and chi-squared tests. RESULTS Pain in the past month was reported by 473 out of 676 (70.0%) older PLWH, 224 out of 357 (62.7%) younger PLWH and 188 out of 295 (63.7%) older HIV-negative controls (P = 0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (P = 0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56 out of 412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current pain had more depressive symptoms, poorer quality-of-life on all domains and greater functional impairment, regardless of age group. CONCLUSION Even in the effective antiretroviral therapy era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain.
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Nkhoma K, Norton C, Sabin C, Winston A, Merlin J, Harding R. Self-management Interventions for Pain and Physical Symptoms Among People Living With HIV: A Systematic Review of the Evidence. J Acquir Immune Defic Syndr 2018; 79:206-225. [DOI: 10.1097/qai.0000000000001785] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Schreiber-Stainthorp W, Sinharay S, Srinivasula S, Shah S, Wang J, Dodd L, Lane HC, Di Mascio M, Hammoud DA. Brain 18F-FDG PET of SIV-infected macaques after treatment interruption or initiation. J Neuroinflammation 2018; 15:207. [PMID: 30007411 PMCID: PMC6046092 DOI: 10.1186/s12974-018-1244-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/29/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although rates of severe HIV-associated neurocognitive disorders have declined in the post-antiretroviral treatment (ART) era, subtle deficits persist, possibly exacerbated by treatment non-adherence. The actual effects of ART interruption/initiation on brain glucose metabolism as a reflection of viral replication and neuroinflammation remain unclear. Our study investigates how treatment initiation and interruption alter brain glucose metabolism in SIV-infected macaques, using 18F-FDG PET in correlation with plasma and CSF viral loads (VL) and cytokine levels. METHODS SIV-infected macaques (n = 7) underwent ART initiation only, ART interruption only, or both. Five uninfected animals served as controls. 18F-FDG PET imaging was performed at baseline and 1, 3, and 6 months after treatment modification. Mean and maximum standardized uptake values (SUV) for the whole-brain and subregions were calculated. Plasma and CSF VL and cytokine levels were measured. Paired t tests evaluated acute changes in whole-brain SUV from baseline to 1 month, while mixed-effect linear regression models evaluated changes over multiple timepoints and correlated SUV values with disease markers. RESULTS ART interruption was associated with increased SUVmean and SUVmax acutely, after 1 month (SUVmean 95% CI [0.044-0.786 g/ml], p = 0.037; SUVmax 95% CI [0.122-3.167 g/ml], p = 0.041). The correlation between SUV and time, however, was not significant when evaluated across all timepoints. Increased SUVmean and SUVmax correlated with decreased CD4+ and CD8+ T-cell counts and increased plasma VL. SUVmax was positively associated with increases in CSF VL, and there were borderline positive associations between SUVmax and IL-2, and between SUVmean and IL-15. The treatment initiation group showed no associations between imaging and disease biomarkers despite viral suppression, reduced cytokine levels, and increased CD4+ and CD8+ T-cell counts. CONCLUSIONS ART interruption is associated with increased brain glucose metabolism within 1 month of treatment cessation, which, in concert with increased levels of pro-inflammatory cytokines in the CSF, may reflect neuroinflammation in the setting of viral rebound. Although we cannot assert neurologic damage in association with cerebral hypermetabolism, it is a concerning outcome of ART non-adherence. Treatment initiation, meanwhile, did not result in significant changes in brain metabolism. HIV-induced neuroinflammation may require a longer period to abate than our follow-up period allowed.
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Affiliation(s)
| | - Sanhita Sinharay
- Center for Infectious Disease Imaging, Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Sharat Srinivasula
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute Campus at Frederick, Frederick, MD USA
| | - Swati Shah
- Center for Infectious Disease Imaging, Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Jing Wang
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute Campus at Frederick, Frederick, MD USA
| | - Lori Dodd
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD USA
| | - H. Clifford Lane
- Clinical and Molecular Retrovirology Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Michele Di Mascio
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD USA
| | - Dima A. Hammoud
- Center for Infectious Diseases Imaging (CIDI), Clinical Center, National Institutes of Health (NIH), 10 Center Drive, Building 10, Room 1C-368, Bethesda, MD 20892 USA
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Mawuntu AH, Mahama CN, Khosama H, Estiasari R, Imran D. Early detection of peripheral neuropathy using stimulated skin wrinkling test in human immunodeficiency virus infected patients: A cross-sectional study. Medicine (Baltimore) 2018; 97:e11526. [PMID: 30045275 PMCID: PMC6078746 DOI: 10.1097/md.0000000000011526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Peripheral neuropathy is a common condition of human immunodeficiency virus (HIV)-infected patients, which often remains undetected. We assessed the performance of stimulated skin wrinkling-eutectic mixture of local anesthetic (SSW-EMLA) test compared with brief peripheral neuropathy screening (BPNS) to detect HIV neuropathy.This is a cross-sectional study conducted in HIV-positive patients. A modified skin wrinkling grading was used to assess SSW-EMLA effect. BPNS-detectable neuropathy was assessed by a combination of neuropathy severity scoring scale (subjective) and objective method of sensory and tendon reflex examination. The SSW-EMLA test accuracy with reference to BPNS was assessed using sensitivity and specificity and predictive values.In a total of 99 HIV patients, 61.6% were males and the majority age group were between 30 and 40 years (52%). The neuropathy detection was SSW-EMLA test 36.4% versus BPNS 15.2% (P = .04). The sensitivity of SSW-EMLA test was 60.0% [95% confidence interval (95% CI) 34.5-81.7], specificity 67% (95% CI 63.3-3-71.7), and overall accuracy of 66.7% (95% CI 58.9-73.2).The SSW-EMLA test detected many more peripheral neuropathy cases than BPNS in HIV patients and has potential as an alternative test for screening for HIV neuropathy in resource-constraint hospitals in Indonesia.
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Affiliation(s)
- Arthur H.P. Mawuntu
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Corry N. Mahama
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Herlyani Khosama
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Riwanti Estiasari
- Neurology Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Darma Imran
- Neurology Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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