HIV Associated Sensory Neuropathy
Background: In the era of highly active antiretroviral therapy (HAART), sensory neuropathies have increased in prevalence. We have documented the frequency and profile of the two most common forms of sensory neuropathies associated with Human Immunodeficiency Virus (HIV) infection and looked int...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2014-07-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/4531/8143_CE[Ra1]_F(DK)_PF1(PAK)_PFA(AK)_PF2(AGAK).pdf |
| Summary: | Background: In the era of highly active antiretroviral therapy
(HAART), sensory neuropathies have increased in prevalence.
We have documented the frequency and profile of the two most
common forms of sensory neuropathies associated with Human
Immunodeficiency Virus (HIV) infection and looked into clinicoelectrophysiological correlates to differentiate the two entities.
Methods: The study population comprised of all consecutive
patients detected to be HIV positive and attending the Neurology
outpatient department (from March 2011 to March 2012) who
were aged ≥ 18 years and were able to give informed consent.
The data were collected from the patient records (including CD4
counts and treatment details) and questionnaire based interview
with each patient. All patients underwent detailed clinical
examination and nerve conduction studies (NCSs).
Results: Among the total study population of 50 patients, there
were 31 men and 19 women. Thirty two patients were in age
range of 21 - 40 years and rest were above 40 years. 25 were
on antiretroviral therapy (18 on regimen containing zidovudine;
seven on regimen containing stavudine). The mean duration of
antiretroviral therapy was 16.6±8.4 months. Low CD4 counts
(<200) were noted in 24 patients (13 of these were on antiretroviral
therapy). Clinically, the patients were classified as asymptomatic
(n=34) and symptomatic (n=16). Among the symptomatic
patients, nine were on antiretroviral therapy since less than one
year (seven of these were on regimen containing stavudine). Ten
patients aged more than 40-years had symptomatic neuropathy.
No significant correlation was found between low CD4 counts
and symptomatic neuropathy (p=0.21). Impaired vibration (100%)
and absent ankle jerks (75%) were commoner than reduced pin
sensitivity (46.6%). Twenty two patients had abnormal NCS
results (18 of these were on antiretroviral therapy). Axonal distal
symmetrical sensory neuropathy was the commonest pattern
noted in 14 patients who were receiving antiretroviral therapy.
Subclinical involvement as evidenced by NCSs was noted in 5
asymptomatic patients who were all on antiretroviral therapy.
Conclusion: Symptomatic neuropathy was seen predominantly
in HIV patients who were on antiretroviral therapy. All patients
receiving stavudine containing regimen had severe symptomatic
neuropathy within 1 year. There was an increase in the likelihood
of symptomatic neuropathy among patients aged > 40 years.
Subclinical neuropathy was common in those on antiretroviral
therapy. Axonal neuropathy was the commonest pattern
noted in patients who were receiving antiretroviral therapy and
demyelinating neuropathy in patients not on antiretroviral therapy.
Surprisingly no significant correlation was found between low
CD4 counts and symptomatic neuropathy. |
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| ISSN: | 2249-782X 0973-709X |