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Incidence of and risk factors for HIV-associated distal sensory
polyneuropathy.
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Neurology 2002 Jun 25;58(12):1764-8
Schifitto G, McDermott MP, McArthur JC, Marder K, Sacktor N, Epstein L,
Kieburtz K;
Dana Consortium on the Therapy of HIV Dementia and Related Cognitive
Disorders.
Department of Neurology, University of Rochester, Rochester, NY 14642, USA.
OBJECTIVE: To assess the incidence of and risk factors for distal sensory
polyneuropathy (DSP) in a cohort of HIV-infected subjects. METHODS: We
followed 272 subjects semiannually for up to 30 months. DSP was diagnosed
if subjects had decreased or absent ankle jerks, decreased or absent
vibratory perception at the toes, or decreased pinprick or temperature in a
stocking distribution. Subjects were further classified at each visit as
having asymptomatic DSP (ADSP) (signs only) or symptomatic DSP (SDSP) if, in
addition to the neurologic signs, paresthesias or pain was reported.
RESULTS: At baseline, 45% of the subjects did not meet criteria for DSP, 20%
met criteria for ADSP, and 35% met criteria for SDSP. Dideoxynucleoside
therapy was used by 23% of the patients, and this treatment was independent
of their neuropathy status. In longitudinal univariate analyses, history of
AIDS diagnoses (hazard ratio [HR] = 1.89; p = 0.02) and lower CD4 cell count
(HR = 0.69; p = 0.0006) were risk factors for incident DSP (ADSP or SDSP).
However, for incident SDSP only, in addition to history of AIDS diagnoses,
mood and neurologic (other than DSP) and functional abnormalities were
significant risk factors. Functional abnormalities remained a significant
risk factor in a multiple regression analysis. The presence of ADSP
and the use of dideoxynucleosides at baseline were not significant risk
factors for incident SDSP. The Kaplan-Meier estimate of the 1-year incidence
of SDSP was 36%.
CONCLUSION: Subjects with moderate-to-severe immunosuppression from HIV
infection commonly have SDSP. However, sex, use of dideoxynucleosides, and
presence of ADSP were not significant risk factors for SDSP.
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