Abstract
Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38–10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26–0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36–1.83 and aOR = 2.17; 95% CI 0.93–5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS’ quality of life.
Highlights
Peripheral neuropathy (PN) in its diverse forms has been reported as the most frequent neurological disorder found in patients with human immunodeficiency viral infection (Keswani et al 2002; Morgello et al 2004; McArthur et al 2005; Ellis et al 2010)
Patients were recruited from the adult HIV outpatient clinic at the infectious disease unit attending about 19,000 people living with HIV/AIDS (PLHIV) at the time of the study, 7000 of which being on antiretroviral therapy (ART)
From the paper-based and filled case report form, data were entered into the Epi Info software and combined with data retrieved from laboratory analyses
Summary
Peripheral neuropathy (PN) in its diverse forms has been reported as the most frequent neurological disorder found in patients with human immunodeficiency viral infection (Keswani et al 2002; Morgello et al 2004; McArthur et al 2005; Ellis et al 2010). PN was shown to be associated with HIV infection itself and in many cases triggered by the respective. (2019) 25:464–474 treatment with antiretroviral agents (Keswani et al 2002; Cornblath and Hoke 2006; Cherry et al 2012; Schutz and Robinson-Papp 2013; Margolis et al 2014). The introduction of antiretroviral therapy (ART) has led to significant worldwide reduction of morbidity and mortality caused by HIV/AIDS (Scanlon and Vreeman 2013; UNAIDS 2016). Growing evidence of occurring unwanted side complications through exposure to these medications has led to increasing use of safer ART in many countries (World Health Organisation 2015; Ngassa Mbenda et al 2017)
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