HIV-related Neuropathy: Difference between revisions
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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | ||
== Introduction == | |||
== Epidemiology == | |||
The estimated pooled frequency of DSN in the pre ART era in Africa was 27% (11–37%)149,152,153. A much lower frequency of 3.9% was reported in a single large study from SA154. The worldwide prevalence during the same period ranged between 20–57%149. A frequency of 50% was reported in HIV2 in one study in West Africa using just one sign+/- symptoms45. In the post ART era in Africa there was a significant increase in frequency of DSN with pooled frequencies of DSN of 52% (36–60%)149,150,152,153,155–159. This increase was attributed to the widespread use of dideoxynucleoside reverse transcriptase inhibitors as a first line ART, in particular stavudine with the neuropathy typically beginning 5–6 months post starting ART153,158,160. In a recent study from SA involving a cohort of patients 2 years after starting ART (60% on stavudine) a slight increase in the frequency of symptomatic DSN from baseline 16% to 18% was reported with a 50% decrease in significant pain161. The rate of symptomatic DSN decreased from 22 to 17% in another study in SA involving 2nd line ART patients with an almost 2 year follow up period, notably the rate of asymptomatic DSN in that study increased from 21% to 29%162. Some studies from West Africa report a decrease in the frequency of DSN at three months post starting ART which may have been too early to observe this side effect of stavudine163,164. | |||
== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
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add text here relating to '''''clinically relevant''''' anatomy of the condition<br> | add text here relating to '''''clinically relevant''''' anatomy of the condition<br> | ||
== | == Pathological Process == | ||
add text here relating to the mechanism of injury and/or pathology of the condition<br> | add text here relating to the mechanism of injury and/or pathology of the condition<br> | ||
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== Types == | == Types == | ||
DSN is the most common | === Distal Sensory Neuropathy (DSN) === | ||
DSN is the most common type of neuropathy in PLWH.<ref name=":0">Howlett WP. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794503/ Neurological disorders in HIV in Africa: a review.] African health sciences. 2019 Aug 20;19(2):1953-77.</ref> It affects the distal extremities (more commonly the feet) and is caused by axonal damage secondary to dorsal root inflammation. | |||
'''Signs and symptoms''' include<ref name=":0" />: | |||
* Burning pain and numbness in the soles of the feet/palms of the hands - this ascends symmetrically | |||
* Reduced or absent reflexes | |||
* Impaired light touch sensation | |||
* Impaired proprioception of the affected region | |||
'''Risk factors''' for developing DSN<ref name=":0" />: | |||
* Advanced HIV disease | |||
* Lower CD4 count and high viral load | |||
* A history of prior TB or alcohol abuse | |||
* ART regime that includes Dideoxynucleoside revers transcriptase inhibitors (NRTIs), especially Stavudine | |||
== | === Mononeuropathy === | ||
The most common mononeuropathy are: | |||
HIV | * '''Facial nerve palsy (Bell's palsy):''' Usually occurs during the early, asymptomatic stages of HIV | ||
* '''Herpes zoster reactivation:''' One of the earliest signs of HIV, and affects the thoracic and trigeminal nerve | |||
== Management / Interventions == | |||
* '''HIV infection control -''' early diagnosis and treatment with ARVs | |||
* '''Drug regime alteration if associated with ARVs -''' Avoiding dideoxynucleoside reverse transcriptase inhibitors | |||
* '''Pain control -''' With neuropathic medication (amitriptyline, gabapentin, pregabalin) | |||
* '''Education -''' On possible other causes of neuropathy (alcohol, diabetes and Vit B6 deficiency secondary to isoniazid)<br> | |||
== Differential Diagnosis | == Differential Diagnosis == | ||
add text here relating to the differential diagnosis of this condition<br> | add text here relating to the differential diagnosis of this condition<br> | ||
== Resources | == Resources == | ||
add appropriate resources here | add appropriate resources here |
Revision as of 17:48, 20 October 2023
Top Contributors - Melissa Coetsee, Kim Jackson and Pacifique Dusabeyezu
Introduction[edit | edit source]
Epidemiology[edit | edit source]
The estimated pooled frequency of DSN in the pre ART era in Africa was 27% (11–37%)149,152,153. A much lower frequency of 3.9% was reported in a single large study from SA154. The worldwide prevalence during the same period ranged between 20–57%149. A frequency of 50% was reported in HIV2 in one study in West Africa using just one sign+/- symptoms45. In the post ART era in Africa there was a significant increase in frequency of DSN with pooled frequencies of DSN of 52% (36–60%)149,150,152,153,155–159. This increase was attributed to the widespread use of dideoxynucleoside reverse transcriptase inhibitors as a first line ART, in particular stavudine with the neuropathy typically beginning 5–6 months post starting ART153,158,160. In a recent study from SA involving a cohort of patients 2 years after starting ART (60% on stavudine) a slight increase in the frequency of symptomatic DSN from baseline 16% to 18% was reported with a 50% decrease in significant pain161. The rate of symptomatic DSN decreased from 22 to 17% in another study in SA involving 2nd line ART patients with an almost 2 year follow up period, notably the rate of asymptomatic DSN in that study increased from 21% to 29%162. Some studies from West Africa report a decrease in the frequency of DSN at three months post starting ART which may have been too early to observe this side effect of stavudine163,164.
Clinically Relevant Anatomy
[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Pathological Process[edit | edit source]
add text here relating to the mechanism of injury and/or pathology of the condition
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Symptoms:
Diagnostic Procedures[edit | edit source]
Based on medical history, clinical examination and laboratory tests
EMG
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Types[edit | edit source]
Distal Sensory Neuropathy (DSN)[edit | edit source]
DSN is the most common type of neuropathy in PLWH.[1] It affects the distal extremities (more commonly the feet) and is caused by axonal damage secondary to dorsal root inflammation.
Signs and symptoms include[1]:
- Burning pain and numbness in the soles of the feet/palms of the hands - this ascends symmetrically
- Reduced or absent reflexes
- Impaired light touch sensation
- Impaired proprioception of the affected region
Risk factors for developing DSN[1]:
- Advanced HIV disease
- Lower CD4 count and high viral load
- A history of prior TB or alcohol abuse
- ART regime that includes Dideoxynucleoside revers transcriptase inhibitors (NRTIs), especially Stavudine
Mononeuropathy[edit | edit source]
The most common mononeuropathy are:
- Facial nerve palsy (Bell's palsy): Usually occurs during the early, asymptomatic stages of HIV
- Herpes zoster reactivation: One of the earliest signs of HIV, and affects the thoracic and trigeminal nerve
Management / Interventions[edit | edit source]
- HIV infection control - early diagnosis and treatment with ARVs
- Drug regime alteration if associated with ARVs - Avoiding dideoxynucleoside reverse transcriptase inhibitors
- Pain control - With neuropathic medication (amitriptyline, gabapentin, pregabalin)
- Education - On possible other causes of neuropathy (alcohol, diabetes and Vit B6 deficiency secondary to isoniazid)
Differential Diagnosis[edit | edit source]
add text here relating to the differential diagnosis of this condition
Resources[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Howlett WP. Neurological disorders in HIV in Africa: a review. African health sciences. 2019 Aug 20;19(2):1953-77.