Continued high prevalence and adverse clinical impact of human immunodeficiency virus-associated sensory neuropathy in the era of combination antiretroviral therapy: the CHARTER Study.

Abstract

OBJECTIVE:

To provide updated estimates of the prevalence and clinical impact of human immunodeficiency virus-associated sensory neuropathy (HIV-SN) and neuropathic pain due to HIV-SN in the combination antiretroviral therapy (CART) era.

DESIGN:

Prospective, cross-sectional analysis. Clinical correlates for HIV-SN and neuropathic pain, including age, exposure to CART, CD4 levels, plasma viral load, hepatitis C virus infection, and alcohol use disorders, were evaluated in univariate and multivariate models.

SETTING:

Six US academic medical centers.

PATIENTS:

One thousand five hundred thirty-nine HIV-infected individuals enrolled in the CNS (Central Nervous System) HIV Anti-Retroviral Therapy Effects Research study.

MAIN OUTCOME MEASURES:

The presence of HIV-SN, defined by 1 or more clinical signs (diminished vibration or sharp sensation in the legs and feet; reduced ankle reflexes) in a distal, symmetrical pattern. Neuropathic pain was defined as aching, stabbing, or burning in a similar distribution. The effect on quality of life was assessed with the Medical Outcomes Study HIV Health Survey.

RESULTS:

We found HIV-SN in 881 participants. Of these, 38.0% reported neuropathic pain. Neuropathic pain was significantly associated with disability in daily activities, unemployment, and reduced quality of life. Risk factors for HIV-SN after adjustment were advancing age (odds ratio, 2.1 [95% confidence interval, 1.8-2.5] per 10 years), lower CD4 nadir (1.2 [1.1-1.2] per 100-cell decrease), current CART use (1.6 [1.3-2.8]), and past "D-drug" use (specific dideoxynucleoside analogue antiretrovirals) (2.0 [1.3-2.6]). Risk factors for neuropathic pain were past D-drug use and higher CD4 nadir.

CONCLUSIONS:

Neuropathic pain and HIV-SN remain prevalent, causing substantial disability and reduced quality of life even with successful CART. The clinical correlates of HIV-SN have changed with the evolution of treatment. These findings argue for redoubled efforts to determine HIV-SN pathogenesis and the development of symptomatic and neuroregenerative therapies.

• Authors: Ronald J Ellis, Debralee Rosario, David B Clifford, Justin C McArthur, David Simpson, Terry Alexander, Benjamin B Gelman, Florin Vaida, Ann Collier, Christina M Marra, Beau Ances, J Hampton Atkinson, Robert H Dworkin, Susan Morgello, Igor Grant, CHARTER Study Group
• Journal: Archives of neurology (Arch Neurol) Vol. 67 Issue 5 Pg. 552-8 (May 2010) ISSN: 1538-3687 [Electronic] United States
• PMID: 20457954 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Retroviral Agents

Topics

• Activities of Daily Living
• Adult
• Alcoholism (epidemiology)
• Anti-Retroviral Agents (adverse effects)
• CD4 Lymphocyte Count
• Comorbidity
• Cross-Sectional Studies
• Employment
• Female
• HIV Infections (complications, drug therapy)
• Hepatitis C (epidemiology)
• Humans
• Immunocompetence (immunology)
• Immunocompromised Host (immunology)
• Male
• Middle Aged
• Peripheral Nervous System Diseases (chemically induced, epidemiology, virology)
• Prevalence
• Prospective Studies
• Quality of Life
• Risk Factors
• Viral Load
• Virus Replication (immunology)