CLINICAL PATTERN OF HIV-ASSOCIATED SENSORY NEUROPATHY AMONG ADULTS WITH HIV INFECTION IN KANO

Abstract

BACKGROUND: Following the introduction of highly active anti-retroviral therapy (HAART) in 1996, the spectrum of neurologic complications associated with HIV infection has changed, dramatically reducing the incidence of immunodeficiency associated CNS disorders such as toxoplasmosis, cryptococcal meningitis, primary CNS lymphoma, and progressive multifocal leukoencephalopathy (PML). However, HIV-associated sensory neuropathy (HIV–SN) continues to be a common neurological complication and is of great burden in people living with HIV infection (PLHIV). Also HIV-associated sensory neuropathy affects adherence to antiretroviral drugs (ARV) in people living with HIV infection, as patients with the neuropathy tend to ascribe the development of peripheral neuropathy (PN) partly to medications they take for the disease. It has been reported that peripheral neuropathy is likely to be enhanced by various demographic and health status characteristics, among the people living with HIV infection in western countries. In spite of the importance of knowledge about peripheral neuropathy among people living with HIV infection, there is scarcity of data on its prevalence, associated factors and independent predictors of peripheral neuropathy in this cohort of patients in Nigeria and particularly in Kano State, with a large population of patients living with HIV infection, and hence the need for this current study.
OBJECTIVES: The aims of this study were to determine the frequency of HIV-associated sensory neuropathy among people living with HIV infection in Kano State, and to determine the relationship between development of HIV-associated sensory neuropathy and some demographic, clinical and laboratory characteristics of the patients living with HIV infection in the state.
METHODS: The study was a cross-sectional hospital based survey where a total of 380 patients with HIV infection (190 on HAART and 190 HAART naïve) were enrolled. Data was collected using non-probability sampling method. A semi-structured questionnaire, which contained the brief peripheral neuropathy screening (BPNS) tool of AIDS Clinical Trial Group (ACTG) protocol was administered to adult HIV-infected individuals attending follow-up at Aminu Kano teaching hospital (AKTH) and Murtala Mohamed specialist hospital (MMSH) respectively. Neuropathy was defined by the presence of any of the symptoms listed in the brief peripheral neuropathy screen tool on both feet and presence of one or more of reduced ankle jerk or reduced vibration sense in the big toe.
Demographic, clinical and laboratory details were documented. Patients with other risk factors for distal symmetrical polyneuropathy such as diabetes mellitus, renal impairment, and those currently on antituberculosis drugs were excluded from the study.
RESULTS: The mean age of the studied subjects was 37.4± 9.9 years, with a range of 18-70 years. The median CD4 count of the subjects was 496 cells/mm3, and interquartile range of 287.5-618.3 cells/mm3. Of the total 380 subjects studied, 30.8% (117/380) were males while 69.2% (263/380) were females with male to female ratio of 1:2.3. The overall frequency of HIV-associated sensory neuropathy was 29.2% (111/380). The frequency of HIV-associated sensory neuropathy in the HAART- experienced group was 42.1% (80/190), and 16.3% (31/190) in the HAART- naive group, (OR, 3.730 {95% CI: 2.307 – 6.032}; P <0.001). The determinants of occurrence of HIV-associated sensory neuropathy were explored using variables obtained in this study. Specifically, the effect of age group (above 40 years), gender, height (above 1.7 meters), HAART use and CD4 count level (≤200 cells/mm3), were evaluated using multivariate logistic regression analysis. The age above 40 years (OR, 4.773 {95% CI; 2.701 – 8.435}; P <0.001) and CD4 count level ≤200 cells/mm3 (OR, 2.15 {95% CI; 1.162 – 3.99}; P=0.003), were independent predictors of occurrence of sensory neuropathy, with the strongest determinant being the age above 40 years.
CONCLUSION: The current study showed that HIV-associated sensory neuropathy is quite common among people living with HIV infection in Kano State. Advancing age (>40 years) and low CD4 count (<200 cells/mm3), were found to be independent risk factors for HIV associated sensory neuropathy.

CLINICAL PATTERN OF HIV-ASSOCIATED SENSORY NEUROPATHY AMONG ADULTS WITH HIV INFECTION IN KANO