HIV neuropathy in South Africans: frequency, characteristics, and risk factors.
The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection.
Maritz
Jean
J
Division of Neurology, Department of Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa.
Benatar
Michael
M
Dave
Joel A
JA
Harrison
Taylor B
TB
Badri
Motasim
M
Levitt
Naomi S
NS
Heckmann
Jeannine M
JM
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D015984:Causality; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010292:Paresthesia / Q000453:epidemiology; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D018119:Stavudine / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology
D019380:Anti-HIV Agents; D018119:Stavudine