title: High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania.
abstract: OBJECTIVE
  To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl.
  
  
  METHODS
  We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART-naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign.
  
  
  RESULTS
  Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2-3.3) and older participants (aOR 2.7, 95% CI 1.1-6.2 for age 40 + vs. <30 years).
  
  
  CONCLUSIONS
  Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV-infected patients to an additional avoidable risk of DSP. Access to non-neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.
authors.affiliation: North Middlesex University Hospital NHS Trust, London, UK. swm2002@imperial.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Mullin
authors.forename: A
authors.initials: A
authors.lastname: Temu
authors.forename: S
authors.initials: S
authors.lastname: Kalluvya
authors.forename: A
authors.initials: A
authors.lastname: Grant
authors.forename: H
authors.initials: H
authors.lastname: Manji
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D016049:Didanosine / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D017933:Peripheral Nervous System / Q000187:drug effects*; D011115:Polyneuropathies / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000821:virology; D015995:Prevalence; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects; D013636:Tanzania / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D018119:Stavudine; D016049:Didanosine