Publication Abstract Display
Type: Published Manuscript
Title: Continued high prevalence and adverse clinical impact of human immunodeficiency virus–associated sensory neuropathy in the era of combination antiretroviral therapy: The CHARTER Study.
Authors: Ellis R, Rosario D, Clifford D, McArthur J, Simpson D, Alexander T, Gelman B, Vaida F, Collier A, Marra C, Ances B, Atkinson JH, Dworkin R, Morgello S, Grant I, and the CHARTER Study Group
Year: 2010
Publication: Archives of Neurology
Volume: 67 Issue: 5 Pages: 552-558
Abstract:Objective: To provide updated estimates of the preva- lence and clinical impact of human immunodeficiency virus−associated sensory neuropathy (HIV-SN) and neu- ropathic pain due to HIV-SN in the combination anti- retroviral 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 Ner- vous System) HIV Anti-Retroviral Therapy Effects Re- search study. Main Outcome Measures: The presence of HIV-SN, defined by 1 or more clinical signs (diminished vibra- tion 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 simi- lar distribution. The effect on quality of life was as- sessed 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 activi- ties, unemployment, and reduced quality of life. Risk fac- tors 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 qual- ity of life even with successful CART. The clinical cor- relates of HIV-SN have changed with the evolution of treat- ment. These findings argue for redoubled efforts to determine HIV-SN pathogenesis and the development of symptomatic and neuroregenerative therapies.

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