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Clinical diagnosis of sensory neuropathy in HIV patients treated with tenofovir: A 6‐month follow‐up study
Author(s) -
Pillay Prinisha,
Wadley Antonia L.,
Cherry Catherine L.,
Karstaedt Alan S.,
Kamerman Peter R.
Publication year - 2019
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/jns.12349
Subject(s) - medicine , stavudine , incidence (geometry) , asymptomatic , cart , cohort , cumulative incidence , surgery , antiretroviral therapy , pediatrics , human immunodeficiency virus (hiv) , viral load , family medicine , optics , engineering , mechanical engineering , physics
Background Sensory neuropathy (SN) is a common and often painful neurological condition associated with HIV‐infection and its treatment. However, data on the incidence of SN in neuropathy‐free individuals initiating combination antiretroviral therapies (cART) that do not contain the neurotoxic agent stavudine are lacking. Aims We investigated the 6‐month incidence of SN in ART naïve individuals initiating tenofovir (TDF)‐based cART, and the clinical factors associated with the development of SN. Methods 120 neuropathy‐free and ART naïve individuals initiating cART at a single center in Johannesburg, South Africa were enrolled. Participants were screened for SN using clinical signs and symptoms at study enrolment and approximately every 2‐months for a period of ~6‐months. Diagnostic criteria for symptomatic SN was defined by the presence of at least one symptom (pain/burning, numbness, paraesthesias) and at least two clinical signs (reduced vibration sense, absent ankle reflexes or pin‐prick hypoaesthesia). Diagnostic criteria for asymptomatic SN required at least two clinical signs only (as above). Results A total of 88% of the cohort completed three visits within the 6‐month period. The 6‐month cumulative incidence of neuropathy was 140 cases per 1000 patients (95% CI: 80‐210) at an incidence rate of 0.37 (95% CI: 0.2‐0.5) per person year. Height and active tuberculosis (TB) disease were independently associated with the risk of developing SN ( P < .05). Interpretation We found that within the first 6 months of starting cART, incident SN persists in the post‐stavudine era, with 11 (9%) of individuals developing asymptomatic SN, and 9 (8%) developing symptomatic SN.