Abstract
BackgroundHIV-associated peripheral neuropathy (PN) is common in people living with HIV. Its management is mostly symptomatic utilising pharmacological approaches.ObjectivesThis study determined the effects of an exercise intervention on PN among Rwandan people living with HIV receiving antiretroviral therapy (ART).MethodsA 12-week single-blinded randomised controlled trial using the Brief Peripheral Neuropathy Screen (BPNS) as the assessment tool tested the effects of an exercise intervention on PN, followed by a 12-week non-intervention period. A total of 120 people with HIV- associated PN on ART were randomised to an exercise or no exercise group. Both groups continued receiving routine care. A bivariate analysis using Pearson’s chi-square test for significant differences in PN symptoms and signs, between groups, at baseline, after the 12 weeks intervention and 12 weeks post-intervention using generalised linear regression models to determine predictors of treatment outcomes was undertaken, utilising an intention-to-treat analysis (alpha p ≤ 0.05).ResultsAt 12 weeks, the intervention group compared to the control: neuropathic pain 70% versus 94% (p < 0.005), PN symptoms severity – mild and/or none in 85% versus 60% (p < 0.001) and radiation of PN symptoms reduced, 80% versus 37% (p < 0.001). There were no differences in PN signs at 12 weeks intervention and at 12 weeks post-intervention. Having changed the antiretroviral (ARV) and having developed PN symptoms after the start on ARVs predicted treatment improvement, while demographic factors did not predict any treatment outcome.ConclusionA physiotherapist-led exercise intervention improved PN symptoms, but with non-significant improvement in PN signs. Factors related to early diagnosis and treatment of PN were facilitators for the improvement of PN symptoms.Clinical implicationsPhysiotherapist-led exercises should be integrated into the routine management of people living with HIV on ART with PN symptoms.
Highlights
HIV-associated peripheral neuropathy (PN) is common in people living with HIV
A systematic review conducted by Phillips et al (2010) to determine the effectiveness of pharmacological management of HIV-associated peripheral neuropathy (HIV-PN) indicated that only tropical capsaicin 8%, smoked cannabis and recombinant human nerve growth factor, reduced HIV-PN
Physiotherapist-led exercise seems to improve PN symptoms as the results of this study indicate that all the PN symptoms among the participants who exercised for 12 weeks improved as compared to the control group which had no improvement
Summary
HIV-associated peripheral neuropathy (PN) is common in people living with HIV. The most common PN is distal sensory polyneuropathy (DSP) often assessed and diagnosed with the Brief Peripheral Neuropathy Screen (BPNS) (Tumusiime et al 2014a). Both pharmacological and non-pharmacological modalities are recommended for the management of PN (Nicholas et al 2007). Non-pharmacological management that includes exercise programmes and lifestyle changes is recommended (Ahmad & Goucke 2002). There is limited literature on the effects of these non-pharmacological modalities, exercise for the management of HIV-PN. It is hypothesised that exercise would be effective in the prevention or reduction of PN symptoms and signs because of various causes, including HIV-PN (Dobson, McMillan & Li 2014)
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