Abstract
BackgroundProtease inhibitors (PI)s have been associated with distal sensory polyneuropathy (DSP) and metabolic complications in high-income countries. No data exist in Africans where second-line antiretroviral therapy (ART) often include PIs.MethodWe performed a cross-sectional study to assess the DSP frequency and metabolic risk factors in community-based South Africans taking ritonavir-boosted lopinavir as PI. Examination findings categorized subjects as having DSP (≥1 neuropathic sign) or symptomatic DSP [DSP with symptom(s)]. Fasting-state glucose and lipid profiles were assessed. We compared the ritonavir/lopinavir-group to a nested group on first-line ART [dideoxy-nucleoside reverse transcriptase inhibitors (d-drugs)] selected from a dataset collected at the same time and matched for d-drug exposure.ResultsThe ritonavir/lopinavir-group (n = 86) consisted predominantly of women (84 %) with a median age of 36 years (IQR 32–41). The median current CD4+ count was 489 cells/μL (IQR 291–665). The median exposure time to ritonavir/lopinavir was 18 months (IQR 10–26) and to d-drugs, 24 months (IQR 16–38). DSP was present in 78 % and symptomatic DSP in 48 %; symptoms were most frequently of moderate intensity. Only age independently associated with DSP and symptomatic DSP (p = 0.08 and p = 0.04, respectively). None of the metabolic syndrome components showed associations with DSP or symptomatic DSP despite a trend towards hypertriglyceridemia overall. The ritonavir/lopinavir-group had less DSP compared to the d-drug only group (p = 0.002) but the frequency of symptomatic DSP was similar (p = 0.49).ConclusionRitonavir-boosted lopinavir did not add additional risk to developing DSP in this community-based African cohort after a median of 18 months on second-line ART.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-015-0073-8) contains supplementary material, which is available to authorized users.
Highlights
Protease inhibitors (PI)s have been associated with distal sensory polyneuropathy (DSP) and metabolic complications in high-income countries
The ritona‐ vir/lopinavir-group had less DSP compared to the d-drug only group (p = 0.002) but the frequency of symptomatic DSP was similar (p = 0.49)
Study population characteristics The ritonavir/lopinavir-group (n = 86) had a median age of 36 years and the majority were women (84 %). Their median current CD4+ count was 480 cells/μL the nadir pre-antiretroviral therapy (ART) CD4+ counts were frequently
Summary
Protease inhibitors (PI)s have been associated with distal sensory polyneuropathy (DSP) and metabolic complications in high-income countries. No data exist in Africans where second-line antiretroviral therapy (ART) often include PIs. Distal sensory polyneuropathy (DSP) is a common neurological complication amongst people living with HIV. In a cross-sectional community-based sample, we reported a high frequency of DSP among South Africans receiving first-line anti-retroviral therapy (ART), which at that time, contained stavudine. PI use among individuals from developed countries, usually older males, has been associated with the development of diabetes and hypertriglyceridemia [8, 9], which are associated with DSP [7, 10, 11] These cohorts differ substantially from the vast majority of people presently receiving PIs in sub-Saharan Africa; for example, African cohorts are young, predominantly women, with very low hepatitis C co-infectivity and intravenous drug abuse [12].
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