Clinical assessment of peripheral neuropathy in HIV-infected children on antiretroviral therapy in rural South Africa

Abstract

Peripheral neuropathy is a well-known side effect of antiretroviral therapy (ART) in adult patients and is particularly related to the use of nucleoside reverse transcriptase inhibitors. This class of drugs is included in all first-line paediatric ART regimens in Africa, but data on the prevalence of neuropathy in children are scarce. In this cross-sectional study, 182 HIV-infected children on ART in rural South Africa were assessed for peripheral neuropathy using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). Peripheral neuropathy was defined as NSS ≥ 5 or NDS ≥ 3. Neurological assessment was completed for 174 children (96%). Symptoms of neuropathy were reported in NSS by 48 children (28%; 95% confidence interval (CI) 21-34%), and signs were observed in NDS in 25 children (14%; 95% CI 12-16%). A diagnosis of peripheral neuropathy was established in 42 children (24%; 95% CI 18-30%). Independent risk factors for peripheral neuropathy were co-trimoxazole prophylaxis (adjusted odds ratio 0.45; 95% CI 0.21-0.95, p = 0.036) and didanosine use (adjusted odds ratio 12; 95% CI 1.3-116, p = 0.030). Peripheral neuropathy as determined by clinical assessment is a common condition in African children on ART.