Abstract
BackgroundPeripheral neuropathy (PN) is a neurological complication of untreated Human Immunodeficiency Virus (HIV) infection or exposure to certain antiretroviral drugs. In Tanzania where HIV is a major public health problem, the burden of HIV associated peripheral neuropathy has not yet been well defined in children.Thisstudy investigated the prevalence and associated factors for peripheral neuropathy among children living with HIV, attending Care and Treatment Clinic (CTC) at Muhimbili National Hospital (MNH).Materials and methodsA cross-sectional study was conducted among 383 HIV positive children aged 5 to 18 years at MNH, CTC in Dar es Salaam between October to December 2019. All participants provided written assent/consent. Structured questionnaires designed for this study was used to collect data and screening for peripheral neuropathy was done on each participant using the Pediatric modified Total Neuropathy Score (Ped m TNS) that includes subjective and objective assessment. A score of 5 or greater on the Ped m TNS was used to define peripheral neuropathy. Data analysis was done using SPSS Version 23.ResultsThe prevalence of peripheral neuropathy among HIV infected children was 14.1 % (95 % CI (10.8 − 18 %). Common neuropathic symptoms were numbness, tingling sensation, reduced ankle reflexes and reduced sensation to light touch and pain that was limited to the toes. Low CD4 cell count (OR = 12.21; 95 % CI3.75–39.66; p = 0.0001), high viral load (OR = 10.54; 95 % CI 3.19–34.77; p = 0.0001), ART regime containing NRTI plus PI (OR = 3.93; 95 % CI 1.43– 10.74; p = 0.01) and the last exposure to isoniazid more than 6 months ago (OR = 3.71; 95 % CI 1.57–8.77; p = 0.003) were independent predictors for peripheral neuropathy.ConclusionPeripheral neuropathy is common among HIV infected children attending CTC at MNH and its frequency increases with advanced disease. The choice of ART regimen and other drugs for treating comorbid conditions should carefully be evaluated.
Highlights
Peripheral neuropathy (PN) is a neurological complication of untreated Human Immunodeficiency Virus (HIV) infection or exposure to certain antiretroviral drugs
Low CD4 cell count (OR = 12.21; 95 % CI3.75–39.66; p = 0.0001), high viral load (OR = 10.54; 95 % confidence intervals (CI) 3.19–34.77; p = 0.0001), Anti-retroviral Therapy (ART) regime containing Nucleoside Reverse Transcriptase Inhibitor (NRTI) plus Protease Inhibitor (PI) (OR = 3.93; 95 % CI 1.43– 10.74; p = 0.01) and the last exposure to isoniazid more than 6 months ago (OR = 3.71; 95 % CI 1.57–8.77; p = 0.003) were independent predictors for peripheral neuropathy
In the multivariate analysis model we found that low CD4 cell count (OR = 12.21; 95 % CI 3.75–39.66; p = 0.0001), high viral load (OR = 10.54; 95 % CI 3.19–34.77; p = 0.0001), ART regime containing NRTI plus PI (OR = 3.93; 95 % CI 1.43– 10.74; p = 0.01) and the last exposure to isoniazid more than 6 months ago (OR = 3.71; 95 % CI 1.57–8.77; p = 0.003) were independent predictors for PN (Table 4)
Summary
Peripheral neuropathy (PN) is a neurological complication of untreated Human Immunodeficiency Virus (HIV) infection or exposure to certain antiretroviral drugs. Peripheral neuropathy (PN) is a frequent neurological complication of Human Immunodeficiency Virus (HIV).The incidence increases with advanced disease or severe immunosuppression. It can be a result of cytopathic effects of the virus or the neurotoxiceffects of certain antiretroviral medications that causes inflammatory mediated neuronal cell damage [1]. This study aims to evaluate the magnitude of PN among HIV infected children using a simple clinical screening tool. This will facilitate early detection of this condition so that timely interventions can be offered to prevent its progression to debilitating symptoms later in life
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