High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Abstract

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200cells/μl. Methods We recruited participants attending ART clinic into four groups: >6months ART exposure and (i) CD4<200cells/μl or (ii) CD4>200cells/μl (ART/CD4<200 and ART/CD4>200, respectively); ART-naïve and (iii) CD4<200cells/μl or iv)CD4>200cells/μl (noART/CD4<200 and noART/CD4>200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38years, median CD4 142cells/μl) were enrolled in the ART/CD4<200 group, 78 (17 men, median age 37years, median CD4 345cells/μl) in ART/CD4>200, 81 (30 men, median age 37years, median CD4 128cells/μl) in noART/CD4<200 and 86 (22 men, median age 33years, median CD4 446cells/μl) in noART/CD4>200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4<200 to 20.9% in noART/CD4>200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2-3.3) and older participants (aOR 2.7, 95% CI 1.1-6.2 for age 40+vs. <30years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200cells/μl. Stavudine and didanosine expose HIV-infected patients to an additional avoidable risk of DSP. Access to non-neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed. © 2011 Blackwell Publishing Ltd.