| Publication Abstract Display | | Type: Poster | | Title: Neuropathic pain contributes to an excess of unemployment and disability in HIV infection: the CHARTER Study. | | Authors: Ellis RJ, Rosario D, Clifford D, McArthur J, Simpson D, Alexander TJ, Marra C, Gelman BB, Atkinson JH, Dworkin RH, Vaida F, Grant I | | Date: 10-2009 | | Abstract:Background: Neuropathic pain due to HIV sensory
neuropathy (HIV-SN) is believed to cause significant
disability, but no reports have evaluated the impact
of painful HIV-SN on occupational status and
dependence in activities of daily living.
Methods: HIV-SN, neuropathic pain, occupational
status and dependence in activities of daily living
were assessed in 1,539 HIV-infected individuals
enrolled in a prospective, observational study at 6
US sites. HIV-SN was defined as at least one clinical
sign in a symmetrical, bilateral pattern on neurological
examination. Signs included distal loss of
reflexes, vibratory sensation and ability to discriminate
sharp from dull. Employment was assessed by
using a self-report questionnaire and dependence in
instrumental activities of daily living (IADLs) was
determined according to a modified Lawton-Brody
scale.
Results: Subjects were mostly middle-aged
(meansd 43.28.5) men (76.6%) who met 1993
CDC criteria for AIDS (63.0%). Median [IQR] nadir
and current CD4 counts were 175 [49300] and
419 [263602] cells/uL. 71.1% took combination
antiretroviral therapy (cART), 13.6% took neurotoxic
dideoxynucleoside antiretrovirals (d-drugs)
and 38.2% had prior exposure (median duration,
36 [1368] months). HIV-SN prevalence was 57%
and neuropathic pain was reported by 29% of
subjects, ranging from slight (11%) to severe (5%).
Increasing numbers of abnormal HIV-SN exam findings
were associated with increasing pain severity
(pB.0001). 74% of subjects were unemployed, and
19% were dependent in activities of daily living.
The likelihood of being unemployed was significantly
increased among subjects with HIV-SN (OR
1.5 [95% CI: 1.2, 1.9]) or neuropathic pain of any
severity (OR 1.8 [1.3, 2.3]), and remained significant
after adjusting for current and nadir CD4, cART,
d-drug use, plasma viral load (VL), neuropsychological
impairment, current major depression and
demographic factors such age and education. More
severe pain was associated with a significantly
greater likelihood of being unemployed. The likelihood
of being dependent in IADLs was significantly
increased among subjects with HIV-SN (OR
1.4 [1.11.8]) or neuropathic pain compared to those
without (OR 2.5 [1.9, 3.3]), and remained significant
after adjusting for current and nadir CD4, cART, ddrug
use, plasma VL, neuropsychological impairment,
current major depression and demographic
factors. More severe pain was associated with a
greater likelihood of dependence in IADLs.
Conclusions: Despite improvements in both the
effectiveness and tolerability of antiretroviral regimens,
painful HIV-SN remains common and contributes
to an excess burden of unemployment
and disability in activities of daily living. |
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