Date Published: January 29, 2019
Publisher: Public Library of Science
Author(s): Kedir Sany Adem, Balamurugan Janakiraman, Berihu Fisseha Gebremeskel, Mulugeta Bayisa Chala, Asmare Yitayeh Gelaw, Kassahun Alemu, Marcel Yotebieng.
Antiretroviral therapy has surely increased the life expectancy of people living with HIV. However, long term complications like HIV associated sensory neuropathy has a negative impact on quality of life among people living with HIV (PLHIV). In Ethiopia, lack of data on magnitude of the burden and predictors of HIV associated sensory neuropathy in many resource limited setting has led to under diagnosis and eventually under management of HIV-SN. Hence, this study was set out to establish the burden of HIV-associated sensory neuropathy and, its association with demographic, health and clinical characteristics among people living with HIV in Ethiopia.
Cross-sectional study was conducted to assess the prevalence of HIV-associated sensory neuropathy and the associated factors among adult HIV patients at University of Gondar Teaching Hospital, Gondar, Ethiopia. Brief Peripheral Neuropathy Screening tool validated by AIDs Clinical trial group was used for screening HIV-associated sensory neuropathy. Data were analyzed descriptively and through uni- and multivariate logistic regression.
In total 359 adult PLHIV with a mean age of 36.5± 9.07 years participated, their median duration of HIV infection was 60 months (IQR 36–84) and their median CD4 count 143cells/μL (IQR 69.5–201.5). Age above 40 years, anti-tuberculosis regimen, tallness, and exposure to didanosine contained antiretroviral therapy were found to be associated with HIV-associated sensory neuropathy (AOR 1.82, 1.84, 1.98 and 4.33 respectively).
More than half of the HIV patients who attended HIV care clinic at University of Gondar hospital during the study period were found to present with peripheral sensory neuropathy. Higher age, tallness, TB medication, and didanosine in ART were significantly associated with HIV-SN as screened by effective diagnostic (BPNS) tool.
Life expectancy of people living with HIV has considerably increased after antiretroviral therapy (ART) era making HIV infection a chronic illness . An estimated 5.5 HIV infected people among 6.6 million those who were saved from death between 1995 and 2012 live in low-middle income countries , . Many debilitating complications related to HIV infection and ART regime are the recent spotlight . HIV-associated sensory neuropathy (HIV-SN) is one of those complications among people living with HIV and the most common cause of chronic neuropathic pain, loss sensation, paraesthesia, foot ulcers, unemployment, poor, patient adherence to treatment, follow-ups, and poor quality of life [5–8]. The absence of neuro-regenerative therapies and proven ineffectiveness of analgesics in treatment of neuropathic pain among patients with HIV-SN clearly demonstrates the lack of effective treatments and the need for early diagnosis of patients at risk of HIV-SN [9–12].
The BPNS as an screening tool in examining HIV-SN in HIV-infected patients has been validated using physiologic (quantitative sensory threshold testing) and pathologic (epidermal nerve fiber density) testing as the gold standards . Definition of HIV-SN consistent with BPNS tool is presence of both subjective and objective findings. However, the criteria of BPNS that a patient must have both self-reported neuropathic symptoms and clinical signs to be classified as HIV-SN may eventually result in omission of some patients with mild HIV-SN . With this diagnostic criterion of BPNS tool, there are always chances for substantial underestimation of peripheral neuropathy (PN) .
HIV-SN was found to be highly prevalent among HIV infected patient at the University of Gondar Hospital, Ethiopia As the life expectancy of people with HIV increases the prevalence of HIV-SN will also increase, making it a major clinical issue and burden particularly in resource limited settings. It is known that managing neuropathic pain is a challenging problem in HIV infected. Hence, early detection of HIV-SN permits patient education, control of modifiable risk and confounding factors, and better chances of improvement with added choices of managements. Simple and validated neurological assessment tools to detect early HIV-SN or those at risk among all HIV patients should be used routinely. We found that the occurrence of HIV-SN increases with advanced age and height thereby necessitating early diagnosis in these risk groups. Physician’s drug choice in HAART and the anti-tuberculosis regime shall consider the role of these drugs and possible association with HIV-SN especially in Sub-Saharan terrains.