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Persisting High Prevalence of HIV Distal Sensory Peripheral Neuropathy in the Era of Combination ART: Correlates in the CHARTER Study
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Reported by Jules Levin
CROI 2009 Feb 8-12 Montreal
Ronald J. Ellis, M.D., Ph.D.1, Debralee Rosario, M.P.H.1, David Clifford, M.D.2, Justin C. McArthur, M.B.B.S.3, David Simpson, M.D.4, Terry Alexander, R.N.1, Christina Marra, M.D.2, Benjamin B. Gelman, M.D.,PhD.5, Igor Grant, M.D.1
1University of California, San Diego, California; 2Washington University, St. Louis, Missouri; 3Johns Hopkins University, Baltimore, Maryland; 4Mt. Sinai School of Medicine, New York, New York; 5University of Texas Medical Branch, Galveston, Texas
AUTHOR CONCLUSIONS
Distal Sensory Polyneuropathy was found to affect more than half of individuals living with HIV, with a particularly high prevalence among those currently taking ART.
These findings suggest that the recovery of peripheral nerves with ART I it occurs, is incomplete.
Significant risk factors for DSPN in the multivariate regression were lower CD4 nadir, advanced age, current ART use, prior d-drug use and prior opiate abuse/dependence.
The finding that individuals with higher CD4 nadirs were less likely to ave DSPN suggests that earlier ART treatment might prevent the onset of neuropathic pain.
The effect of current ART use on DSPN was independent of prior d-drug use, consistent with at least 2 possible explanations: (1) DSPN is promoted by advanced disease requiring ART or (2) ARVs other than d-drugs confer some degree of neurotoxicity. (from Jules: a 3rd explanation is that metabolic complications may worsen neuropathy such diabetes, lab metabolic/lipid abnormalities, insulin resistance).
The frequent occurrence od DSPN despite CART reinforces the need for novel treatments to manage neuropathic pain and promote neuroregeneration and recovery.
OBJECTIVE
To assess changes in prevalence, risk factors, and clinical impact of both distal sensory polyneuropathy and neuropathic pain in HIV.
BACKGROUND
Before combination antiretroviral therapy (CART) was introduced, neuropathic pain due to Distal Sensory Polyneuropathy (DSPN) was the most prevalent neurologic complaint in HIV.
DSPN symptoms include hyperalgesia, tingling, numbness, and pain.
CART has resulted in substantial immune reconstitution among the HIV population.
The use of "d-drugs" (D4T, DDI), known to be associated with the onset of neuropathic pain, has declined.
As the HIV population ages and antiretroviral therapy evolves, updated estimates of DSPN and neuropathic pain frequency, associated risk factors and overall impact are needed to guide therapeutic strategies.
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