Role of metabolic syndrome components in HIV-associated sensory neuropathy.
OBJECTIVE
Sensory neuropathy is a common peripheral nerve complication of HIV infection and highly active antiretroviral therapy. Metabolic syndrome (MetS), a cluster of risk factors for atherosclerosis and microvascular disease, is associated with sensory neuropathy in HIV-uninfected (HIV-negative) persons. We examined whether MetS or its components predispose individuals to HIV-associated sensory neuropathy (HIV-SN).


METHODS
From a prospective multicenter cohort of 1556 HIV-positive patients, a subgroup (n = 130) with fasting laboratory tests and sensory neuropathy assessment was selected.


METHODS
Sensory neuropathy was defined by symmetrically decreased reflexes or sensation loss in the legs. MetS was defined by presence of at least three risk factors: mean arterial pressure of at least 100 mmHg; triglycerides (TRGs) of at least 150 mg/dl and high-density lipoprotein cholesterol of less than 40 mg/dl for male patients, less than 50 mg/dl for female patients; body mass index of more than 25 kg/m; plasma glucose (GLU) of at least 100 mg/dl and self-reported diabetes mellitus type 2. Multivariate logistic regression examined the association between HIV-SN and MetS.


RESULTS
After controlling for HIV-SN risk factors such as age, CD4 current, length of HIV infection, use of dideoxynucleoside reverse transcriptase inhibitors and protease inhibitors, MetS was not associated with HIV-SN (P = 0.72). However, when each MetS component was assessed, elevated TRG was a significant risk factor for HIV-SN. From the larger cohort, both diabetes mellitus type 2 (odds ratio = 1.4, P < 0.01) and elevated TRG (odds ratio = 1.4, P = 0.01) were risk factors for HIV-SN.


CONCLUSIONS
The risk of HIV-SN was increased for diabetes mellitus type 2 and elevated TRG but not for other MetS components. Both increase the risk of sensory neuropathy in HIV-populations, but the mechanism(s) remains unclear.
Ances
Beau M
BM
Department of Neurology, Washington University, St Louis, 660 South Euclid Avenue, Box 8111, St Louis, MO 63110, USA. bances@wustl.edu
Vaida
Florin
F
Rosario
Debralee
D
Marquie-Beck
Jennifer
J
Ellis
Ronald J
RJ
Simpson
David M
DM
Clifford
David B
DB
McArthur
Justin C
JC
Grant
Igor
I
McCutchan
J Allen
JA
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology* / Q000821:virology; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000503:physiopathology* / Q000821:virology; D011446:Prospective Studies; D012678:Sensation Disorders / Q000209:etiology / Q000503:physiopathology* / Q000821:virology