69. Increasing Prevalence of Neuropathy in the Era of Highly Active Antiretroviral Therapy (HAART)

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Session 15 Oral Abstract Session
Neuropathogenesis
Session Time: Tuesday, 10 am - 12:30 pm
Room 606-609

12:00 69.

Increasing Prevalence of Neuropathy in the Era of Highly Active Antiretroviral Therapy (HAART)
C. Cherry*¹, J. McArthur^2, , K. Costello¹, I. Woolley¹, A. Mijch¹, and S. Wesselingh¹
¹Monash Univ., Alfred Hosp., Melbourne, Victoria, Australia and ²Johns Hopkins Univ., Baltimore, MD

Background: Sensory neuropathy (SN) is the most common neurological complication of HIV infection. Prevalence data for SN are predominately derived from cohorts studied before the introduction of HAART, with observed risk factors for SN including prolonged illness and advanced immunosuppression. We aimed to describe the prevalence and risk factors for clinical SN in the era of HAART and to compare this with data obtained in our clinic in 1993.
Methods: HIV-infected outpatients attending a university-affiliated teaching hospital underwent a standardised screening examination for symptoms and signs of SN. Results were compared with patient characteristics and treatment details, and multivariate analysis was undertaken using a logistic regression model. Screening of HIV-infected outpatients for SN was undertaken in the same clinic in 1993, enabling a comparison of current data with data collected before the availability of HAART.
Results: 140 patients were assessed over a 4-month period. The patients screened were not different from the overall clinic population in terms of age, duration of known HIV infection, CD4 count, viral load, or exposure to antiretroviral drugs. 84 (60%) of 140 patients reported symptoms suggestive of SN and 62 (44%) also had at least 1 objective sign (clinical SN). This is a significant increase from the 14% prevalence of SN described in the same clinic in 1993 (p<0.001). On univariate analysis, SN was associated with increasing patient age, increasing duration of HIV infection, having been prescribed antiretroviral therapy, and having been prescribed dideoxynucleosides (DDx). SN was not increased among patients with AIDS, high viral loads, lower CD4 cell counts, or lower nadir CD4 cell counts. The factors independently associated with an increased risk of SN were having ever been prescribed a DDx (OR=26, 95% CI=5-129, p<0.0001) and increasing age (OR=1.1, 95% CI 1-1.2, p=0.0002).
Conclusions: The prevalence of clinical SN has increased in our clinic since the availability of HAART. Previously described risk factors for SN including duration of illness and degree of immunosuppression no longer apply. The independent risk factors for SN are having ever been prescribed a DDx and increasing age.

Š2002 9^th Conference on Retroviruses and Opportunistic Infections