by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

July 7, 2020

Featured Literature:

Vecchio AC et al. and the AIDS Clinical Trials Group 5199 and 5271 study team. Distal Sensory Peripheral Neuropathy in Human Immunodeficiency Virus Type 1– Positive Individuals Before and After Antiretroviral Therapy Initiation in Diverse Resource-Limited Settings. Clinical Infectious Diseases. July 1, 2020; 71(1):158–65

Distal sensory peripheral neuropathy (DSPN) has been a known complication of HIV infection for many years – although the prevalence appears to have declined in the post-ART era. This study from the International Neurological Study Trials Group (ACTG- 5199) assessed the prevalence of DSPN in seven resource-limited settings for ART– naive people living with HIV (PLWH) compared with matched participants who were not HIV infected and also in PLWH virally suppressed on ART. Subjects (n=860) with a CD4+ count <300 cells/mm3 at baseline underwent a standardized neurological examination and functional status assessment before and every 6 months after starting ART. Matched individuals (n=2400) not HIV infected underwent the same clinical examinations at a single visit. Associations between covariates with DSPN at entry were assessed using the χ2 test. Persons with HIV who were virally suppressed on ART were evaluated using generalized estimating equations. Prior to ART initiation, 21% of PLWH had neuropathy compared to 8% of those who were not HIV-infected. The overall prevalence of DSPN among those virally suppressed on ART decreased from 20% at week 48 to 15% at week 144 and 10% at week 192. Longitudinally, DSPN was more common in older individuals and those with less education. Persons with HIV and DSPN were more likely to report inability to work and depression than those without DSPN. There was no association observed between specific ART regimens and DSPN.

Author’s Commentary:

DSPN is another one of the older HIV-related clinical conditions that appears to be less frequently diagnosed in the post-ART era. This may be, in part, due to lack of neurological screening of patients. The reported prevalence remains high in patients, especially those who are not on ART. The data from this study are consistent with historical observations that many, but not all patients with DSPN will improve with viral suppression and immune recovery after starting ART. However, chronic neuropathic pain and sensory loss can lead to unemployment, depression, and increased medical costs. More research is needed to improve methods for prevention and treatment of DSPN.

The author has no conflicts of interest to disclose.

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