Cargando…

Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV

OBJECTIVE: Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. METHODS: Ambulatory, community‐dwelling HIV serop...

Descripción completa

Detalles Bibliográficos
Autores principales: Ellis, Ronald J., Diaz, Monica, Sacktor, Ned, Marra, Christina, Collier, Ann C., Clifford, David B., Calcutt, Nigel, Fields, Jerel A., Heaton, Robert K., Letendre, Scott L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359117/
https://www.ncbi.nlm.nih.gov/pubmed/32619341
http://dx.doi.org/10.1002/acn3.51097
_version_ 1783558981378113536
author Ellis, Ronald J.
Diaz, Monica
Sacktor, Ned
Marra, Christina
Collier, Ann C.
Clifford, David B.
Calcutt, Nigel
Fields, Jerel A.
Heaton, Robert K.
Letendre, Scott L.
author_facet Ellis, Ronald J.
Diaz, Monica
Sacktor, Ned
Marra, Christina
Collier, Ann C.
Clifford, David B.
Calcutt, Nigel
Fields, Jerel A.
Heaton, Robert K.
Letendre, Scott L.
author_sort Ellis, Ronald J.
collection PubMed
description OBJECTIVE: Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. METHODS: Ambulatory, community‐dwelling HIV seropositive individuals were recruited at six research centers. Clinical evaluations at baseline and 12 years later determined neuropathy signs and distal neuropathic pain (DNP). Additional assessments measured activities of daily living and quality of life (QOL). Factors potentially associated with DSP and DNP progression included disease severity, treatment, demographics, and co‐morbidities. Adjusted odds ratios were calculated for follow‐up neuropathy outcomes. RESULTS: Of 254 participants, 21.3% were women, 57.5% were non‐white. Mean baseline age was 43.5 years. Polyneuropathy prevalence increased from 25.7% to 43.7%. Of 173 participants initially pain‐free, 42 (24.3%) had incident neuropathic pain. Baseline risk factors for incident pain included unemployment (OR [95% CI], 5.86 [1.97, 17.4]) and higher baseline body mass index (BMI) (1.78 [1.03, 3.19] per 10‐units). Participants with neuropathic pain at follow‐up had significantly worse QOL and greater dependence in activities of daily living than those who remained pain‐free. INTERPRETATION: HIV DSP and neuropathic pain increased in prevalence and severity over 12 years despite high rates of viral suppression. The high burden of neuropathy included disability and poor life quality. However, substantial numbers remained pain‐free despite clear evidence of neuropathy on exam. Protective factors included being employed and having a lower BMI. Implications for clinical practice include promotion of lifestyle changes affecting reversible risk factors.
format Online
Article
Text
id pubmed-7359117
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-73591172020-07-17 Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV Ellis, Ronald J. Diaz, Monica Sacktor, Ned Marra, Christina Collier, Ann C. Clifford, David B. Calcutt, Nigel Fields, Jerel A. Heaton, Robert K. Letendre, Scott L. Ann Clin Transl Neurol Research Articles OBJECTIVE: Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. METHODS: Ambulatory, community‐dwelling HIV seropositive individuals were recruited at six research centers. Clinical evaluations at baseline and 12 years later determined neuropathy signs and distal neuropathic pain (DNP). Additional assessments measured activities of daily living and quality of life (QOL). Factors potentially associated with DSP and DNP progression included disease severity, treatment, demographics, and co‐morbidities. Adjusted odds ratios were calculated for follow‐up neuropathy outcomes. RESULTS: Of 254 participants, 21.3% were women, 57.5% were non‐white. Mean baseline age was 43.5 years. Polyneuropathy prevalence increased from 25.7% to 43.7%. Of 173 participants initially pain‐free, 42 (24.3%) had incident neuropathic pain. Baseline risk factors for incident pain included unemployment (OR [95% CI], 5.86 [1.97, 17.4]) and higher baseline body mass index (BMI) (1.78 [1.03, 3.19] per 10‐units). Participants with neuropathic pain at follow‐up had significantly worse QOL and greater dependence in activities of daily living than those who remained pain‐free. INTERPRETATION: HIV DSP and neuropathic pain increased in prevalence and severity over 12 years despite high rates of viral suppression. The high burden of neuropathy included disability and poor life quality. However, substantial numbers remained pain‐free despite clear evidence of neuropathy on exam. Protective factors included being employed and having a lower BMI. Implications for clinical practice include promotion of lifestyle changes affecting reversible risk factors. John Wiley and Sons Inc. 2020-07-03 /pmc/articles/PMC7359117/ /pubmed/32619341 http://dx.doi.org/10.1002/acn3.51097 Text en © 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Research Articles
Ellis, Ronald J.
Diaz, Monica
Sacktor, Ned
Marra, Christina
Collier, Ann C.
Clifford, David B.
Calcutt, Nigel
Fields, Jerel A.
Heaton, Robert K.
Letendre, Scott L.
Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV
title Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV
title_full Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV
title_fullStr Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV
title_full_unstemmed Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV
title_short Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV
title_sort predictors of worsening neuropathy and neuropathic pain after 12 years in people with hiv
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359117/
https://www.ncbi.nlm.nih.gov/pubmed/32619341
http://dx.doi.org/10.1002/acn3.51097
work_keys_str_mv AT ellisronaldj predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT diazmonica predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT sacktorned predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT marrachristina predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT collierannc predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT clifforddavidb predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT calcuttnigel predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT fieldsjerela predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT heatonrobertk predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT letendrescottl predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv
AT predictorsofworseningneuropathyandneuropathicpainafter12yearsinpeoplewithhiv