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NEUROLOGY 2009;73:315-320
© 2009 American Academy of Neurology

Age and height predict neuropathy risk in patients with HIV prescribed stavudine

C. L. Cherry, MBBS, PhD, J. S. Affandi, BSc(Hons), D. Imran, MD, E. Yunihastuti, MD, K. Smyth, BSc(Hons), S. Vanar, MD, A. Kamarulzaman, MBBS and P. Price, PhD

From the Burnet Institute (C.L.C.), Monash University, and The Alfred Hospital, Melbourne, Australia; School of Pathology and Laboratory Medicine (J.S.A., P.P.), University of Western Australia, Perth; Pokdisus Clinic (D.I., E.Y.), Cipto Mangunkusumo Hospital and University of Indonesia, Jakarta; Australian National University (K.S.), Canberra; and University of Malaya (S.V., A.K.), Kuala Lumpur.

Address correspondence and reprint requests to Dr. Catherine L. Cherry, Infectious Diseases Unit, The Alfred Hospital, Prahran, Victoria 3181, Australia kate.cherry{at}med.monash.edu.au

Objective: Sensory neuropathy is a common problem in HIV-infected patients and is the dose-limiting toxicity of stavudine. Affordable methods of predicting neuropathy risk are needed to guide prescribing in countries where some use of stavudine remains an economic necessity. We therefore aimed to identify factors predictive of neuropathy risk before antiretroviral use.

Methods: A total of 294 patients attending clinics in Melbourne, Kuala Lumpur, and Jakarta were enrolled in a cross-sectional neuropathy screening program in 2006. Neuropathy was defined by the presence of symptoms and signs on the AIDS Clinical Trials Group Brief Peripheral Neuropathy Screen. Demographic, laboratory, and treatment details were considered as possible risk factors for neuropathy. The role of patient demographics in predicting stavudine neuropathy were then assessed in 181 patients who reported that they were free of neuropathy symptoms when first prescribed this drug.

Results: The prevalence of neuropathy was 42% in Melbourne (n = 100), 19% in Kuala Lumpur (n = 98), and 34% in Jakarta (n = 96). In addition to treatment exposures, increasing age (p = 0.002) and height (p = 0.001) were independently associated with neuropathy. Age and height cutoffs of ≥170 cm or ≥40 years predicted neuropathy. Among 181 patients who were asymptomatic before stavudine exposure, the risk of neuropathy following stavudine was 20% in younger, shorter patients, compared with 66% in older, taller individuals.

Conclusions: Stavudine neuropathy risk increases with patient age and height. Prioritizing older and taller patients for alternative agents would be an inexpensive strategy to reduce neuropathy rates in countries where the burden of HIV disease limits treatment options.

Abbreviations: AUC = area under the curve; CI = confidence interval; HAART = highly active antiretroviral therapy; ROC = receiver operating characteristic.

Received January 5, 2009. Accepted in final form April 23, 2009.

Supported by a grant from the Australian Centre for HIV and Hepatitis Research (ACH2).

Disclosure: Author disclosures are provided at the end of the article.






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