1
|
Gnonlonfoun DD, Sowanou A, Gnigone P, Gbessemehlan A, Choki B, Agbetou M, Houeze R, Agassounon R, Metogbe Hountovo A, Adoukonou T, Magne J, Boumediene F, Preux PM, Houinato D. Knowledge, attitudes and practices of general practitioners on peripheral neuropathies in Benin in 2021. Int J Neurosci 2024:1-9. [PMID: 38465511 DOI: 10.1080/00207454.2024.2328709] [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: 03/18/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE First healthcare actors in neurological diseases management, General Practitioners (GPs) still limited in the assessment of Peripheral Neuropathies (PN). This study assesses the knowledge, attitudes, practices (KAP) of GPs on PN in Benin in 2021 and identifying associated factors to low KAP. MATERIALS AND METHODS It was a cross-sectional study conducted from 20 November 2020 to 30 June 2021 which included GPs registered in the National Order of Physicians in Benin and interns in last year of medical studies (MS). An overall KAP score of 24 points was derived. KAP levels were low (score < 17), medium (17 to 19) and high (score ≥ 20). Multivariable regression models were performed to identify factors associated with low KAP. RESULTS 645/1,066 participants (60.5%) were included in the study with median age 28 years [Interquartile range IQR: 26-30 years], and 442 (68.5%) were male. The KAP level was low in 70.1%. 16.7% had a low knowledge of polyneuropathy manifestations, 35% perceived PN as an incurable disease. Lack of knowledge on PN before MS (adjusted Odds-ratio aOR = 1.6 [95% confidence interval CI: 1.1-2.3]), and no postgraduate training on PN (aOR = 1.8 [95% CI: 1.--3.0]) were associated with low overall KAP level. Working in rural area (aOR = 0.4 [95%CI: 0.2-0.7]), and being an intern (aOR = 0.6 [95%CI: 0.4-0.9]) were associated with better overall KAP level. CONCLUSION This study highlights the need for better training with strong emphasis on PN during the MS and the organization of postgraduate training for GPs; the cornerstone for improving the management of PN in Benin.
Collapse
Affiliation(s)
- Dieu Donné Gnonlonfoun
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Arlos Sowanou
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Pupchen Gnigone
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Antoine Gbessemehlan
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Blaise Choki
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | | | - Richard Houeze
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Rhodya Agassounon
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | | | | | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| |
Collapse
|
2
|
Donné Gnonlonfoun D, Sowanou A, Gnigone P, Gbessemehlan A, Nyangui Mapaga J, Aballo W, Choki B, Magne J, Boumediene F, Preux PM, Houinato D. Prevalence and associated factors with peripheral neuropathies in the general population in the rural area of Adjohoun in Benin. J Clin Neurosci 2023; 109:32-38. [PMID: 36669428 DOI: 10.1016/j.jocn.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Peripheral neuropathies (PN) are a group of neurological conditions related to damage to the peripheral nervous system. Due to their wide diversity, few studies in sub-Saharan Africa have explored their epidemiology in general population. Our objective was to study the prevalence and associated factors with PN in general population in Adjohoun in Benin. METHODS A cross-sectional study has been conducted from February to March 2019 and included people aged ≥ 18 years old living in Adjohoun, Benin. Following a screening phase for PN (using World Health Organization questionnaire for major neurological diseases), a neurologist made a diagnosis after in-depth clinical examinations completed in some cases by electroneuromyography. The EFNS (European Federation of Neurological Societies) 2010 criteria was used for chronic inflammatory demyelinating polyneuropathy diagnosis. Data such as age, occupation, consanguinity, alcohol consumption, diabetes, hypertension were collected. Association between independent variables and PN were investigated using multivariable logistic regression models. RESULTS In total, 1 655 participants were included, mean age 41.4 ± 16.7 years; 64.8 % are female. The overall prevalence of PN was 6.9 % (95 %CI: 5.7 %-8.2 %). The main types of PN were: polyneuropathies 4.8 % (95 %CI: 3.8 %-5.9 %); polyradiculoneuropathies 1.6 % (95 %CI: 1.0 %-2.2 %). Factors independently associated with PN were age ≥ 40 years (adjusted Odds Ratio aOR = 19.6; 95 %CI: 8.2-46.3), diabetes (aOR = 1.8; 95 %CI: 1.08-2.99) and hypertension (aOR = 1.6; 95 %CI: 1.02-2.5). CONCLUSION The prevalence of PN was high in the rural commune of Adjohoun in Benin. Actions on its modifiable associated factors such as diabetes and hypertension could help reduce the proportion of PN and their potential harmful consequences.
Collapse
Affiliation(s)
- Dieu Donné Gnonlonfoun
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin; University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin; Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
| | - Arlos Sowanou
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Pupchen Gnigone
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Antoine Gbessemehlan
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin; Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | | | - Wilson Aballo
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Blaise Choki
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin; University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| |
Collapse
|
3
|
Kemp HI, Vollert J, Davies NWS, Moyle GJ, Rice ASC. A Comparison of Self-reported Pain Measures Between Sensory Phenotypes in HIV-associated Sensory Neuropathy. THE JOURNAL OF PAIN 2023; 24:112-127. [PMID: 36116766 DOI: 10.1016/j.jpain.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Painful HIV-associated neuropathy (HIV-SN) is a prevalent co-morbidity of HIV infection. Sensory phenotyping, using quantitative sensory testing (QST) could allow for improved stratification to guide personalized treatment. However, previous methods of QST interpretation have demonstrated limited association with self-reported pain measures. This study sought to identify differences in self-reported pain measures between composite QST-derived sensory phenotypes, and to examine any differences in participants reporting multi-site, multi-etiology chronic pain. In this cross-sectional observational study of participants with HIV (n = 133), individuals were allocated to neuropathy and neuropathic pain groups through clinical assessment and nerve conduction testing. They completed symptom-based questionnaires and underwent standardized QST. Participants were assigned, by pre-determined algorithm, to a QST-derived sensory phenotype. Symptoms were compared between sensory phenotypes. Symptom characteristics and Neuropathic Pain Symptom Inventory scores differed between QST-derived sensory phenotypes: 'sensory loss' was associated with more paroxysmal and paraesthetic symptoms compared to 'thermal hyperalgesia' and 'healthy' phenotypes (P = .023-0.001). Those with painful HIV-SN and additional chronic pain diagnoses were more frequently allocated to the 'mechanical hyperalgesia' phenotype compared to those with painful HIV-SN alone (P = .006). This study describes heterogeneous sensory phenotypes in people living with HIV. Differences in self-reported pain outcomes between sensory phenotypes has the potential to guide future stratified trials and eventually more targeted therapy. PERSPECTIVE: This article presents quantitative sensory testing derived phenotypes, thought to reflect differing pathophysiological pain mechanisms and relates them to self-reported pain measures in people with HIV infection. This could help clinicians stratify patients to individualize analgesic interventions more effectively.
Collapse
Affiliation(s)
- Harriet I Kemp
- Pain Research Group, Imperial College London, London, UK.
| | - Jan Vollert
- Pain Research Group, Imperial College London, London, UK; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany; Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Nicholas W S Davies
- Department of Neurology, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Graeme J Moyle
- Department of HIV Medicine, Chelsea & Westminster NHS Foundation Trust, London, UK
| | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Motwani L, Asif N, Patel A, Vedantam D, Poman DS. Neuropathy in Human Immunodeficiency Virus: A Review of the Underlying Pathogenesis and Treatment. Cureus 2022; 14:e25905. [PMID: 35844323 PMCID: PMC9278792 DOI: 10.7759/cureus.25905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/05/2022] Open
Abstract
This article explores the various causes of the human immunodeficiency virus (HIV), and its associated neuropathy, including the effects of HIV on the nervous system and the long-standing therapy that is often provided to patients with HIV. Several studies regarding the neurotoxic effects of combined antiretroviral therapy (cART) and HIV were reviewed and various hypotheses were discussed. Furthermore, we present the nature of HIV-sensory neuropathy (HIV-SN) among different demographic populations and their subsequent risk factors predisposing them to this condition. It was observed that the incidence of the disease increases in increased survival of the patients as well as in males. Finally, the current approach to HIV-SN and its overlapping features with other causes of peripheral neuropathy have been discussed which demonstrates that a clinical examination is the most important clue for a healthcare professional to suspect the disease. Our main aim was to study the current perspectives and guidelines for diagnosing and managing a patient with HIV-SN to reduce disease prevalence and bring about a more aware frame of mind when following up with an HIV patient.
Collapse
|
6
|
Yitbarek GY, Addis WD, Dagnaw FT, Ayehu GW, Melese BD, Amare TJ, Mulu AT, Bayih WA, Ashagrie BK, Zewde EA, Munye T, Chanie ES, Ebabu W, Alemayehu SA, Arage G, Teshome AA. Magnitude of Peripheral Sensory Neuropathy and Associated Factors Among HIV/AIDS Clients Receiving Care at Public Health Institutions, Northwest Ethiopia. Mol Pain 2022; 18:17448069221089593. [PMID: 35266800 PMCID: PMC9016588 DOI: 10.1177/17448069221089593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: In the mid-1990s, the development of combination antiretroviral
therapy converted HIV infection into a chronic condition, with newly diagnosed
patients now living longer than the general population. HIV affects both the
central and peripheral nerve systems, resulting in a variety of clinical
problems, including peripheral neuropathy, which is a common neurological
consequence. Despite this, there is a scarcity of data on the extent of
peripheral sensory neuropathy and its underlying factors in Ethiopia,
necessitating this study. Objective: The primary goal of this study is to assess
the degree of peripheral sensory neuropathy and its related factors among
HIV/AIDS clients on follow up at public health institutions in Northwest
Ethiopia. Methodology: Institution based cross-sectional study was conducted
from November 1 to 30 December 2020 at selected south Gondar zone public health
institutions ART clinic. Multistage sampling technique was used to select the
study participants. Standardized Questioner adapted from other study was used to
collect the data. Moreover, Brief Peripheral Neuropathy Screening tool (BPNS)
was used to assess peripheral sensory neuropathy. The data were entered with
epi-data manager version 4.4 and analyzed using STATA version 16. Result: A
total of 555 adult PLWHIV agreed to participate in the study, resulting in a
response rate of 96.8%. The prevalence of Peripheral sensory neuropathy was
32.25, 95% CI (28.28, 36.26). The participant’s age, DM comorbidity, viral load
level, and disease clinical stage were all found to have a statistically
significant association with peripheral sensory neuropathy. Conclusion:
Peripheral sensory neuropathy was incredibly common. Accordingly, peripheral
sensory neuropathy was found considerably associated with age, viral load level,
stage of the disease, and DM comorbidity. It is vital to integrate routine
peripheral sensory neuropathy screening strategies for clients who are on ART
follow up for prevention and early identification of the problem.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Tran A, Thakur KT, Nakasujja N, Nakigozi G, Kisakye A, Batte J, Mayanja R, Anok A, Gray RH, Wawer MJ, Rubin LH, Sacktor N, Saylor D. Evaluation of a screening tool for the identification of neurological disorders in rural Uganda. J Neurol Sci 2020; 421:117273. [PMID: 33423010 DOI: 10.1016/j.jns.2020.117273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neurological disorders are common in sub-Saharan African, but accurate neuroepidemiologic data are lacking from the region. We assessed a neuroepidemiological screening tool in a rural Ugandan cohort with high HIV prevalence. METHODS Participants were recruited from the Rakai Neurology Study in rural Rakai District, Uganda. A nurse administered the tool and a sociodemographic survey. 100 participants returned for validation examinations by a neurologist (validation cohort). The diagnostic utility and validity of the instrument were calculated and characteristics of those with and without neurological disorders compared. RESULTS The tool was administered to 392 participants, 48% female, 33% people with HIV, average age 35.1 ± 8.5 years. 33% of the study cohort screened positive for neurologic disorders. These participants were older [mean (SD): 38.3 (9.7) vs. 33.5 (7.1) years, p < 0.001], had a lower Karnofsky score [89.8 (8.4) vs. 93.9 (7.5), p < 0.001] and had a lower body mass index [21.8 (3.3) vs. 22.8 (3.7), p = 0.007] than those who screened negative. Amongst the validation cohort, 54% had a neurological abnormality of which 46% were symptomatic. The tool was 57% sensitive and 74% specific for detecting any neurological abnormality and 80% sensitive and 69% specific for symptomatic abnormalities. CONCLUSIONS We found a lower sensitivity and similar specificity for the screening tool compared with two previous studies. The lower validity in this study was likely due in part to the high percentage of asymptomatic neurological abnormalities detected. This screening tool will require further refinement and cultural contextualization before it can be widely implemented across new populations.
Collapse
Affiliation(s)
- Andy Tran
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University, New York City, NY, USA
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Bagdas D, Paris JJ, Carper M, Wodarski R, Rice ASC, Knapp PE, Hauser KF, Damaj MI. Conditional expression of HIV-1 tat in the mouse alters the onset and progression of tonic, inflammatory and neuropathic hypersensitivity in a sex-dependent manner. Eur J Pain 2020; 24:1609-1623. [PMID: 32533878 DOI: 10.1002/ejp.1618] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/21/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND At least one-third of HIV-1-afflicted individuals experience peripheral neuropathy. Although the underlying mechanisms are not known, they may involve neurotoxic HIV-1 proteins. METHODS We assessed the influence of the neurotoxic HIV-1 regulatory protein, Tat, on inflammatory and neuropathic nociceptive behaviours using transgenic male and female mice that conditionally expressed (or did not express) HIV-1 Tat1-86 in fibrillary acidic protein-expressing glia in the central and peripheral nervous systems. RESULTS Tat induction significantly attenuated the time spent paw-licking following formalin injection (2.5%, i.pl.) in both male and female mice. However, significant sex differences were observed in the onset and magnitude of inflammation and sensory sensitivity following complete Freund's adjuvant (CFA) injection (10%, i.pl.) after Tat activation. Unlike female mice, male mice showed a significant attenuation of paw swelling and an absence of mechanical/thermal hypersensitivity in response to CFA after Tat induction. Male Tat(+) mice also showed accelerated recovery from chronic constrictive nerve injury (CCI)-induced neuropathic mechanical and thermal hypersensitivity compared to female Tat(+) mice. Morphine (3.2 mg/kg) fully reversed CCI-induced mechanical hypersensitivity in female Tat(-) mice, but not in Tat(+) females. CONCLUSIONS The ability of Tat to decrease oedema, paw swelling, and limit allodynia suggests a sequel of events in which Tat-induced functional deficits precede the onset of mechanical hypersensitivity. Moreover, HIV-1 Tat attenuated responses to inflammatory and neuropathic insults in a sex-dependent manner. HIV-1 Tat appears to directly contribute to HIV sensory neuropathy and reveals sex differences in HIV responsiveness and/or the underlying peripheral neuroinflammatory and nociceptive mechanisms.
Collapse
Affiliation(s)
- Deniz Bagdas
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,The Center for the Study for Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Jason J Paris
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS, USA.,Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Moriah Carper
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachel Wodarski
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, UK
| | - Andrew S C Rice
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, UK
| | - Pamela E Knapp
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,Department of Anatomy and Neurobiology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,Institute for Drug and Alcohol Studies, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA
| | - Kurt F Hauser
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,Department of Anatomy and Neurobiology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,Institute for Drug and Alcohol Studies, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.,The Center for the Study for Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.,Translational Research Initiative for Pain and Neuropathy at VCU, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
11
|
Abstract
BACKGROUND Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. METHODS Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. RESULTS Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. CONCLUSION Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.
Collapse
Affiliation(s)
- William P Howlett
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Center for International Health, University of Bergen, Norway
| |
Collapse
|
12
|
Factors associated with distal symmetric polyneuropathies in adult Zambians: A cross-sectional, observational study of the role of HIV, non-antiretroviral medication exposures, and nutrition. J Neurol Sci 2018; 388:61-69. [PMID: 29627032 DOI: 10.1016/j.jns.2018.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Non-antiretroviral (ART) drug exposures and poor nutrition may be important modifiable risk factors for distal symmetric polyneuropathies (DSP) in sub-Saharan Africa. METHODS We conducted a cross-sectional study of DSP prevalence and factors associated with DSP among clinic attendees in urban and rural Zambia. All participants underwent neurologist-performed examination. Laboratory investigations seeking comorbid risk factors for DSP were performed for DSP cases. RESULTS We identified 31/137 (22.6%) HIV+ and 21/177 (11.9%) HIV- DSP cases. DSP prevalence did not differ by urbanicity, although rural participants were significantly more likely to have one asymptomatic DSP sign. Low dietary diversity, history of syphilis, history of tuberculosis, and prior metronidazole and ciprofloxacin use were associated with DSP amongst HIV+ cases, while age and education were associated with DSP in HIV- participants (all p-values < 0·05). In a multivariate logistic regression model, HIV (p = 0·0001) and age (p < 0·0001), and ciprofloxacin exposure (p = 0·01) remained independently associated with DSP. While diabetes was rare, supoptimal micronutrients levels were common among DSP cases regardless of HIV status. CONCLUSIONS While HIV infection is strongly associated with DSP in Zambia, history of non-ART drug exposures and low dietary diversity are also important determinants of DSP in HIV+ individuals. Treatable micronutrient deficiencies were common.
Collapse
|
13
|
Castillo D, Ernst T, Cunningham E, Chang L. Altered Associations between Pain Symptoms and Brain Morphometry in the Pain Matrix of HIV-Seropositive Individuals. J Neuroimmune Pharmacol 2017; 13:77-89. [PMID: 28866752 DOI: 10.1007/s11481-017-9762-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
Pain remains highly prevalent in HIV-seropositive (HIV+) patients despite their well-suppressed viremia with combined antiretroviral therapy. Investigating brain abnormalities within the pain matrix, and in relation to pain symptoms, in HIV+ participants may provide objective biomarkers and insights regarding their pain symptoms. We used Patient-Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms (pain intensity, pain interference and pain behavior), and structural MRI to assess brain morphometry using FreeSurfer (cortical area, cortical thickness and subcortical volumes were evaluated in 12 regions within the pain matrix). Compared to seronegative (SN) controls, HIV+ participants had smaller surface areas in prefrontal pars triangularis (right: p = 0.04, left: p = 0.007) and right anterior cingulate cortex (p = 0.03) and smaller subcortical regions (thalamus: p ≤ 0.003 bilaterally; right putamen: p = 0.01), as well as higher pain scores (pain intensity-p = 0.005; pain interference-p = 0.008; pain-behavior-p = 0.04). Furthermore, higher pain scores were associated with larger cortical areas, thinner cortices and larger subcortical volumes in HIV+ participants; but smaller cortical areas, thicker cortices and smaller subcortical volumes in SN controls (interaction-p = 0.009 to p = 0.04). These group differences in the pain-associated brain abnormalities suggest that HIV+ individuals have abnormal pain responses. Since these abnormal pain-associated brain regions belong to the affective component of the pain matrix, affective symptoms may influence pain perception in HIV+ patients and should be treated along with their physical pain symptoms. Lastly, associations of lower pain scores with better physical or mental health scores, regardless of HIV-serostatus (p < 0.001), suggest adequate pain treatment would lead to better quality of life in all participants.
Collapse
Affiliation(s)
- Deborrah Castillo
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Thomas Ernst
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA
| | - Eric Cunningham
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA
| | - Linda Chang
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA.
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA.
| |
Collapse
|
14
|
Saylor D, Nakigozi G, Nakasujja N, Robertson K, Gray RH, Wawer MJ, Sacktor N. Peripheral neuropathy in HIV-infected and uninfected patients in Rakai, Uganda. Neurology 2017; 89:485-491. [PMID: 28679596 PMCID: PMC5539731 DOI: 10.1212/wnl.0000000000004136] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/11/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence, risk factors, and functional impairment associated with peripheral neuropathy in a prospective cohort of adults in rural Uganda. METHODS Eight hundred participants (400 HIV- and 400 antiretroviral-naive HIV+) in the Rakai Community Cohort Study underwent detailed neurologic evaluations including assessment of neuropathy symptoms, functional measures (Patient Assessment of Own Functioning Inventory and Karnofsky Performance Status scores), and neurologic evaluation by a trained medical officer. Neuropathy was defined as ≥1 subjective symptom and ≥1 sign of neuropathy on examination. Neuropathy risk factors were assessed using log binomial regression. RESULTS Fifty-three percent of participants were men, with a mean (SD) age of 35 (8) years. Neuropathy was present in 13% of the cohort and was more common in HIV+ vs HIV- participants (19% vs 7%, p < 0.001). Older age (relative risk [RR] 1.04, 95% confidence interval [CI] 1.02-1.06), female sex (RR 1.49, 95% CI 1.04-2.15), HIV infection (RR 2.82, 95% CI 1.86-4.28), tobacco use (RR 1.59, 95% CI 1.02-2.48), and prior neurotoxic medication use (RR 2.08, 95% CI 1.07-4.05) were significant predictors of neuropathy in the overall cohort. Only older age was associated with neuropathy risk in the HIV+ (RR 1.03, 95% CI 1.01-1.05) and HIV- (RR 1.06, 95% CI 1.02-1.10) cohorts. Neuropathy was associated with impaired functional status on multiple measures across all participant groups. CONCLUSIONS Peripheral neuropathy is relatively common and associated with impaired functional status among adults in rural Uganda. Older age, female sex, and HIV infection significantly increase the risk of neuropathy. Neuropathy may be an underrecognized but important condition in rural Uganda and warrants further study.
Collapse
Affiliation(s)
- Deanna Saylor
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Gertrude Nakigozi
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noeline Nakasujja
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kevin Robertson
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ronald H Gray
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria J Wawer
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ned Sacktor
- From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW To present an overview of HIV-associated distal symmetric polyneuropathy (HIV-DSP) and other HIV-related peripheral neuropathies in the post-highly active retroviral therapy era. RECENT FINDINGS HIV-DSP has become the most common neurologic complication of HIV largely due to the prolonged survival of HIV-positive patients with the advent of highly active retroviral therapy. HIV-DSP can be attributed to the disease itself or to secondary effects of certain HAART agents, and often the two disease entities cannot be distinguished. HIV-DSP can lead to significant morbidity and interfere with daily activities. Diagnosis can be obtained from a detailed history and neurologic exam revealing absent ankle jerks and abnormal, vibratory perception or decreased pinprick or temperature. Supporting studies include nerve conduction studies and skin biopsy. Although there are no United States Food and Drug Administration-approved treatments for HIV-DSP, clinicians often use off-label medications, including antidepressants, anticonvulsants, topical agents and other analgesics. SUMMARY The prevalence of those affected by HIV-DSP will continue to grow with the aging population of HIV-infected individuals. Compared to the diabetic neuropathy drug trials, trials in both symptomatic and disease-modifying agents for HIV-DSP have had little success. Other forms of HIV-related peripheral neuropathies are discussed briefly, and include acute and chronic inflammatory demyelinating polyneuropathy, autonomic neuropathy, polyradiculopathy, mononeuropathies, mononeuritis multiplex, cranial neuropathies, and amyotrophic lateral sclerosis-like motor neuropathy.
Collapse
|