| Publication Abstract Display | | Type: Poster | | Title: Peripheral nerve function in HIV-infection: electrophysiological and quantitative sensory test results in the CHARTER Study. | | Authors: Al-Lozi M, Ellis R, Vaida F, FitzSimons C, McCutchan JA, McArthur J, Morgello S, Simpson D, Collier A, Marra C, Gelman B, Clifford D, Letendre S, Grant I, for the CHARTER Group | | Date: 04-10-2010 | | Abstract:Background: The electrophysiological characteristics of human immunodeficiency virus- (HIV-) associated peripheral neuropathy with modern CART regimens have not been fully described.
Methods: We analyzed data from HIV+ subjects agreeing to undergo electrophysiological (QST, peroneal and sural NCS) and clinical evaluations in a prospective, multicenter study, CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) between 2004-2009. Studies were reviewed by a single electromyographer. The clinical and electrodiagnostic data were constructed into a modified Total Neuropathy Score (TNS).
Results: Among 209 subjects, mean age 44.1 years (range 23-69), CART use was as follows: Current, n=155 (74%); past n=26 (12%); naive n=28 (13%). Neurotoxic dideoxynucleoside (d-drug) exposure: Current, n=24 (11%); past, n=83 (40%); never, n=102 (49%). 100 (48%) reported distal sensory symptoms. QST-cooling (small nerve fiber function) and QST-vibration (large fibers), were abnormal in 95 (45%) and 39 (19%). Sural sensory and peroneal motor amplitudes were reduced in 76 (36%) and 41 (20%). Sural and peroneal conduction velocities were below 30 m/s in 4 (2%) and 11 (5%). Among subjects with at least one abnormal clinical neuropathy sign, the mean [±SD] TNS was 9.7 [±5.4] vs. 2.5 [±3.1] in those without clinical signs. Among those on CART, TNS was at least mildly abnormal in 90 (58%). Correlates of worse TNS were older age, lower nadir CD4 count, current or past ARV use and current or past d-drug exposure (all p < .001). TNS was not related to gender, hepatitis C serostatus or current CD4 or plasma viral load.
Conclusions: Despite modern CART, most HIV+ subjects showed electrophysiological evidence of peripheral neuropathy, with prevalence increasing according to age, prior immunosuppression and d-drug exposure. Sensory abnormalities exceeded motor, and dysfunction of small fibers exceeded large. |
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