title: Peripheral neuropathy in HIV: prevalence and risk factors.
abstract: OBJECTIVE
  To estimate neuropathic sign/symptom rates with initiation of combination antiretroviral therapy (cART) in HIV-infected ART-naive patients, and to investigate risk factors for: peripheral neuropathy and symptomatic peripheral neuropathy (SPN), recovery from peripheral neuropathy/SPN after neurotoxic ART (nART) discontinuation, and the absence of peripheral neuropathy/SPN while on nART.
  
  
  METHODS
  AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trial participants who initiated cART in randomized trials for ART-naive patients were annually screened for symptoms/signs of peripheral neuropathy. ART use and disease characteristics were collected longitudinally.
  
  
  METHODS
  Peripheral neuropathy was defined as at least mild loss of vibration sensation in both great toes or absent/hypoactive ankle reflexes bilaterally. SPN was defined as peripheral neuropathy and bilateral symptoms. Generalized estimating equation logistic regression was used to estimate associations.
  
  
  RESULTS
  Two thousand, one hundred and forty-one participants were followed from January 2000 to June 2007. Rates of peripheral neuropathy/SPN at 3 years were 32.1/8.6% despite 87.1% with HIV-1RNA 400 copies/ml or less and 70.3% with CD4 greater than 350 cells/μl. Associations with higher odds of peripheral neuropathy included older patient age and current nART use. Associations with higher odds of SPN included older patient age, nART use, and history of diabetes mellitus. Associations with lower odds of recovery after nART discontinuation included older patient age. Associations with higher odds of peripheral neuropathy while on nART included older patient age and current protease inhibitor use. Associations with higher odds of SPN while on nART included older patient age, history of diabetes, taller height, and protease inhibitor use.
  
  
  CONCLUSIONS
  Signs of peripheral neuropathy remain despite virologic/immunologic control but frequently occurs without symptoms. Aging is a risk factor for peripheral neuropathy/SPN.
authors.affiliation: Harvard School of Public Health, 651 Huntington Avenue, Boston, MA 02115, USA. evans@sdac.harvard.edu
authors.forename: Scott R
authors.initials: SR
authors.lastname: Evans
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: Huichao
authors.initials: H
authors.lastname: Chen
authors.forename: Tzu-min
authors.initials: TM
authors.lastname: Yeh
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Giovanni
authors.initials: G
authors.lastname: Schifitto
authors.forename: Kunling
authors.initials: K
authors.lastname: Wu
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.forename: David M
authors.initials: DM
authors.lastname: Simpson
authors.forename: David B
authors.initials: DB
authors.lastname: Clifford
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012367:RNA, Viral; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral