Exposure
to Stavudine and Didanosine Is Significantly Associated with a Heightened Risk
for Symptomatic Sensory Neuropathy in an International Cohort
Sensory neuropathy
is a common finding in HIV positive individuals. In some cases, sensory neuropathy
can be very painful and debilitating. Antiretroviral therapy, especially the use
of specific nucleoside
reverse transcriptase inhibitors (NRTIs), is a risk factor for
the development of these neuropathies. In
the current study, researchers at Johns Hopkins Hospital in Baltimore explored
the association between NRTIs and sensory neuropathies (SNs) and defined the modifying
roles of hepatitis C (HCV),
vitamin B12 deficiency, and impaired glucose tolerance.
The
authors conducted a prospective cohort study of 147 HIV-infected adults at two
sites chosen to emphasize demographic differences. Standardized assessments included
detailed antiretroviral histories, neurologic examinations, skin biopsies for
epidermal nerve quantitation, and quantitative sensory testing. Results 
There were significant differences between subjects
at Johns Hopkins University (JHU) and Monash University (MU) in gender, race,
HIV transmission route, and HCV seroprevalence.
Symptomatic
SN was present in 49% at JHU and 55% at MU and was significantly more common in
those at least age 40 than younger patients.
After
adjusting for site, age, and CD4 cell count, exposure to didanosine
(ddI; Videx) or stavudine
(d4T; Zerit) was associated with a significantly increased likelihood
of symptomatic SN (ddI:
OR = 3.21, 95% CI: 1.56, 6.60; d4T:
OR = 7.66, 95% CI: 2.89, 20.33)
.
Plasma HIV
RNA, lactate, and HCV were not associated with SN.
Quantitative
vibratory testing identified neuropathy with a positive predictive value of 76%
and epidermal nerve fiber densities 59%. |
Based
on these findings, the study authors conclude, “Exposure to stavudine and didanosine
was significantly associated with a heightened risk for symptomatic sensory neuropathy.”
“Reduced
vibration thresholds and epidermal nerve fiber densities had the highest diagnostic
efficiency of the laboratory indicators of neuropathy examined, but were relatively
insensitive in isolation.” 05/05/06 Reference
C
L Cherry, R L Skolasky, L Lal, and others. Antiretroviral
use and other risks for HIV-associated neuropathies in an international cohort.
Neurology
66(6): 867-873. March 28, 2006.
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