High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania
Objectives: To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl.
Methods: We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 200 cells/μl (ART/CD4 200, respectively); ART-naïve and (iii) CD4 200 cells/μl (noART/CD4 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign.
Results: Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs.
Conclusion: Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV-infected patients to an additional avoidable risk of DSP. Access to non-neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.
Mullin, S.; Temu, A.; Kalluvya, S.; Grant, A.; Manji, H. High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania. Tropical Medicine and International Health (2011) 16 (10) 1291-1296. [DOI: 10.1111/j.1365-3156.2011.02825.x]