| Publication Abstract Display | | Type: Poster | | Title: Risk factors for incident neuropathic pain in HIV infection: the CHARTER study. | | Authors: Ellis RJ, Rosario D, Clifford D, McArthur J, Simpson D, Alexander T, Marra C, Morgello S, Gelman BB, Dworkin RH, Vaida F, Grant I | | Date: 10-2009 | | Abstract:Background: Despite dramatic improvements in
overall health among HIV infected individuals on
antiretroviral therapy, neurologic morbidity, including
neuropathic pain, continues to rise. We hypothesized
that asymptomatic peripheral nerve injury,
indicated by abnormal distal sensation and reflexes,
would predict incident neuropathic pain in HIV.
Because previous studies have demonstrated that a
history of opioid dependence increases pain susceptibility,
we also analyzed past DSM-IV-diagnosed
opioid dependence as a risk factor for incident
neuropathic pain.
Methods: In a multicenter, prospective, observational
study, we assessed 449 pain-free HIV-infected
individuals with serial, targeted neurological examinations
and clinical interviews.
Results: At baseline, participants were mostly
middle-aged (mean 43 years) males (81%) with a
median [IQR] CD4 nadir of 181 [50323] cells/uL
and current CD4 437 [278636]. 229 (51%) had at
least one abnormal exam finding consistent with
neuropathy and 82 (18%) had a history of opiate
dependence or abuse. During a median duration of
follow-up of 12 months [IQR 618] among 449
HIV subjects who were pain-free at baseline, 94
developed neuropathic pain. The hazard for developing
incident neuropathic pain was increased (1.97
[95% CI: 1.283.03]) for subjects with one or more
abnormal neuropathy exam findings at baseline as
compared to those without neuropathy. Subjects
with 2 or more abnormal signs were at greatest risk
(HR 2.51 [95% CI: 1.504.19]; p0.0006), followed
by those with only 1 sign (HR 1.65 [95% CI:
1.012.70]; p0.045). Similarly, the hazard was
significantly increased (1.85 [95% CI: 1.172.92])
for past history of opiate dependence or abuse.
Other predictors evaluated including current CD4,
nadir CD4, age, d-drug exposure and hepatitis C
infection were not significant predictors of incident
pain (p0.05). After controlling for each other in a
multivariate proportional hazards model, history of
opiate dependence or abuse and neuropathy (at least
one abnormal sign) remained significant predictors
of incident pain.
Conclusions: Abnormal exam findings and a history
of opiate dependence or abuse predict subsequent
development of neuropathic pain in HIV.
Interventions that reduce the probability of acquiring
abnormal neuropathy signs may also prevent the
development of neuropathic pain. |
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