Prevalent neuropathy in a cohort of HIV-infected Kenyan sex workers using antiretroviral drugs.
BACKGROUND
Several risk factors including stavudine and age have been strongly associated with polyneuropathy. However, conflicting data exist on height as an independent risk factor in polyneuropathy. The objective of this study is to exclude height as an independent polyneuropathy risk factor in a cohort of human immunodeficiency virus (HIV)-infected Kenyan sex workers.


METHODS
This was an analysis of prospectively collected data of treatment-naive subjects initiating either stavudine or tenofovir diphosphate fumarate or zidovudine-based antiretroviral therapy (ART) regimens from January 2008 to August 2012. Polyneuropathy was characterised as burning sensation, numbness, or dysesthesia. The study used arithmetic means of weight (kg) and height (cm) measured in duplicates using calibrated scales.


RESULTS
After exclusion of duplicate data sets and un-confirmed cases of polyneuropathy, the study identified 212 patients without polyneuropathy, 14 pre-ART and 94 post-ART related polyneuropathy cases. Polyneuropathy cases were older but did not differ in demographic, clinical and laboratory parameters at baseline. There was a significant difference in first-line ART regimens with more patients on tenofovir disoproxil fumarate in the post-ART group (p=0.017).


CONCLUSIONS
Polyneuropathy is a common disorder among HIV-infected Kenyan sex workers. These data cannot support the postulated increased risk by height after matching for gender and ART duration. Though stavudine is associated with polyneuropathy, in this study many patients previously not exposed to stavudine developed polyneuropathy. This suggests the involvement of unknown risk factors such as genetic and metabolite differences in the development of polyneuropathy.
University of Nairobi, Institute of Tropical and Infectious Diseases, Directorate of Research Management & Development, State Department of Science & Technology, Nairobi, Kenya; University of Nairobi, Institute of Tropical and Infectious Diseases, University of Manitoba, College of Medicine, Department of Medical Microbiology, Winnipeg, Manitoba, Canada.
Frank Ndaks
FN
Ndakala
University of Nairobi, Institute of Tropical and Infectious Diseases, University of Manitoba, College of Medicine, Department of Medical Microbiology, Winnipeg, Manitoba, Canada.
Julius Otieno
JO
Oyugi
University of Nairobi, College of Health Sciences, School of Pharmacy, Nairobi, Kenya.
Margaret Ng'wono
MN
Oluka
University of Manitoba, College of Medicine, Department of Medical Microbiology, Winnipeg, Manitoba, Canada.
Joshua
J
Kimani
Clinical Immunology and Rheumatology, Hannover Medical School, Germany and German Centre for Infection Research, Germany.
Alexandra
A
Jablonka
Clinical Immunology and Rheumatology, Hannover Medical School, Germany and German Centre for Infection Research, Germany.
Georg Martin Norbert
GM
Behrens
D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D060386:Sex Workers; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects; D000068698:Tenofovir / Q000008:administration & dosage / Q000009:adverse effects; D015215:Zidovudine / Q000008:administration & dosage / Q000009:adverse effects
D019380:Anti-HIV Agents; D015215:Zidovudine; D000068698:Tenofovir; D018119:Stavudine
Antiretroviral therapy; height; polyneuropathy; resource-limited settings; risk factor; sex workers; stavudine; tenofovir disoproxil fumarate