Title |
Peripheral neuropathy in HIV patients in sub-Saharan Africa failing first-line therapy and the response to second-line ART in the EARNEST trial
|
---|---|
Published in |
Journal of NeuroVirology, August 2015
|
DOI | 10.1007/s13365-015-0374-7 |
Pubmed ID | |
Authors |
Alejandro Arenas-Pinto, Jennifer Thompson, Godfrey Musoro, Hellen Musana, Abbas Lugemwa, Andrew Kambugu, Aggrey Mweemba, Dickens Atwongyeire, Margaret J. Thomason, A. Sarah Walker, Nicholas I. Paton, For the EARNEST Trial Team |
Abstract |
Sensory peripheral neuropathy (PN) remains a common complication in HIV-positive patients despite effective combination anti-retroviral therapy (ART). Data on PN on second-line ART is scarce. We assessed PN using a standard tool in patients failing first-line ART and for 96 weeks following a switch to PI-based second-line ART in a large Randomised Clinical Trial in Sub-Saharan Africa. Factors associated with PN were investigated using logistic regression. Symptomatic PN (SPN) prevalence was 22 % at entry (N = 1,251) and was associated (p < 0.05) with older age (OR = 1.04 per year), female gender (OR = 1.64), Tuberculosis (TB; OR = 1.86), smoking (OR = 1.60), higher plasma creatinine (OR = 1.09 per 0.1 mg/dl increase), CD4 count (OR = 0.83 per doubling) and not consuming alcohol (OR = 0.55). SPN prevalence decreased to 17 % by week 96 (p = 0.0002) following similar trends in all study groups (p = 0.30). Asymptomatic PN (APN) increased over the same period from 21 to 29 % (p = 0.0002). Signs suggestive of PN (regardless of symptoms) returned to baseline levels by week 96. At weeks 48 and 96, after adjusting for time-updated associations above and baseline CD4 count and viral load, SPN was strongly associated with TB (p < 0.0001). In summary, SPN prevalence was significantly reduced with PI-based second-line therapy across all treatment groups, but we did not find any advantage to the NRTI-free regimens. The increase of APN and stability of PN-signs regardless of symptoms suggest an underlying trend of neuropathy progression that may be masked by reduction of symptoms accompanying general health improvement induced by second-line ART. SPN was strongly associated with isoniazid given for TB treatment. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 2 | 33% |
United States | 1 | 17% |
Uganda | 1 | 17% |
Netherlands | 1 | 17% |
Unknown | 1 | 17% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 5 | 83% |
Practitioners (doctors, other healthcare professionals) | 1 | 17% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 1 | <1% |
Unknown | 106 | 99% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 18 | 17% |
Student > Master | 18 | 17% |
Student > Bachelor | 11 | 10% |
Student > Ph. D. Student | 8 | 7% |
Student > Doctoral Student | 6 | 6% |
Other | 26 | 24% |
Unknown | 20 | 19% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 37 | 35% |
Nursing and Health Professions | 15 | 14% |
Pharmacology, Toxicology and Pharmaceutical Science | 6 | 6% |
Biochemistry, Genetics and Molecular Biology | 4 | 4% |
Immunology and Microbiology | 4 | 4% |
Other | 16 | 15% |
Unknown | 25 | 23% |