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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] [What about the content of this article? (0)] [Affiliation(s)] [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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