HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cherry, C. L. Articles by McArthur, J. C. Search for Related Content PubMed PubMed Citation Articles by Cherry, C. L. Articles by McArthur, J. C. Related Collections HIV Peripheral neuropathy Risk factors in epidemiology

Antiretroviral use and other risks for HIV-associated neuropathies in an international cohort

From the Johns Hopkins University (R.L.S., J.C., P.H., S.P.R., R.M., K.C., D.T., G.J.E., J.C.M.), Baltimore, MD; and Monash University (C.L.C., S.L.W.), Alfred Hospital, and Burnet Institute (C.L.C., L.L., S.L.W.), Melbourne, Victoria, Australia.

Address correspondence and reprint requests to Dr McArthur, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 6-109, Baltimore, MD 21287; e-mail: jm{at}jhmi.edu

Objective: To explore the association between specific nucleoside reverse transcriptase inhibitors and sensory neuropathies (SNs) and define the modifying roles of hepatitis C (HCV), vitamin B₁₂ deficiency, and impaired glucose tolerance.

Methods: The authors conducted a prospective cohort study of 147 HIV-infected adults at two sites chosen to emphasize demographic differences. Standardized assessments included detailed antiretroviral histories, neurologic examinations, skin biopsies for epidermal nerve quantitation, and quantitative sensory testing.

Results: There were significant differences between subjects at Johns Hopkins University (JHU) and Monash University (MU) in gender, race, HIV transmission route, and HCV seroprevalence. Symptomatic SN was present in 49% at JHU and 55% at MU (² = 4.02, p = 0.134) and was significantly more common in those at least age 40 than younger patients (odds ratio [OR] = 2.87, 95% CI = 1.27, 6.49). After adjusting for site, age, and CD4 cell count, exposure to didanosine (ddI) or stavudine (d4T) was associated with an significantly increased likelihood of symptomatic SN (ddI: OR = 3.21, 95% CI: 1.56, 6.60; d4T: OR = 7.66, 95% CI: 2.89, 20.33). Plasma HIV RNA, lactate, and HCV were not associated with SN. Quantitative vibratory testing identified neuropathy with a positive predictive value of 76% and epidermal nerve fiber densities 59%.

Conclusions: Exposure to stavudine and didanosine was significantly associated with a heightened risk for symptomatic sensory neuropathy. Reduced vibration thresholds and epidermal nerve fiber densities had the highest diagnostic efficiency of the laboratory indicators of neuropathy examined, but were relatively insensitive in isolation.

Supported by NS44807 (J.C.M.) and RR00522 (M. Klag).

Disclosure: The authors report no conflicts of interest.

Received August 9, 2005. Accepted in final form November 30, 3005.

This article has been cited by other articles:

				L. C. Rogers, N. J. Bevilacqua, M. P. DellaCorte, K. Francis, and D. G. Armstrong Charcot's Arthropathy in a Patient with HIV-associated Neuropathy J Am Podiatr Med Assoc, March 1, 2008; 98(2): 153 - 155. [Abstract] [Full Text] [PDF]

				G. J. Ebenezer, J. C. McArthur, D. Thomas, B. Murinson, P. Hauer, M. Polydefkis, and J. W. Griffin Denervation of skin in neuropathies: the sequence of axonal and Schwann cell changes in skin biopsies Brain, October 1, 2007; 130(10): 2703 - 2714. [Abstract] [Full Text] [PDF]

				L. Zhou, D. W. Kitch, S. R. Evans, P. Hauer, S. Raman, G. J. Ebenezer, M. Gerschenson, C. M. Marra, V. Valcour, R. Diaz-Arrastia, et al. Correlates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy Neurology, June 12, 2007; 68(24): 2113 - 2119. [Abstract] [Full Text] [PDF]