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[布基纳法索博博迪乌拉索医院接受高效抗逆转录病毒治疗患者的多发性神经病]

[Polyneuropathies in patients treated with HAART in Bobo-Dioulasso hospital, Burkina Faso].

作者信息

Millogo A, Lankoandé D, Yaméogo I, Yaméogo A A, Sawadogo A B

机构信息

Service de médecine interne, CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso.

出版信息

Bull Soc Pathol Exot. 2008 Feb;101(1):11-3.

Abstract

Peripheral neuropathies (PN) represent the most common neurological manifestation in patients with HIV infection. Introduction of highly active antiretroviral therapy (HAART) had a significant impact on the epidemiology of HIV-associated neuropathies even in poor-resources countries. HIV-infected patients were followed up over a 2-years period from January 2002 to December 2003. PN was clinically diagnosed based on abnormalities of ankle reflexes or vibratory perception and if patients described pain, paresthesia or numbness. Electromyography was not performed in this study Among the 133 HIV-infected patients treated with HAART 31 patients (23 females and 8 males) with 38.8 of mean age were followed up for PN. 95.5% among them were HIV1-infected. According to the availability of the antiretroviral therapy, 9 patients were treated with protocol A including lamivudine + stavudine + nevirapine, 12 patients with protocol B including combination of stavudine + lamivudine + efavirenz, and 10 patients with protocol C with other combinations of antiretroviral therapies. Average CD4 cell count was 229.3/microl and 60% of the sample had < 200 CD4 cell counts at the time of diagnosis. PN occurred within 5.6 months from the institution of the HAART and 80% less than 3 months after the beginning of the treatment. Burning feet syndrome was found in 16.1% of the sample. 45.2% of polyneuropathies occurred in late stage of HIV infection (< 200 CD4/microl). The presence of PN was related to decreased CD4 cells counts and neurotoxic antiretroviral therapy Introduction of HAART has modified the course and the prognosis of HIV infection even in poor resources setting. The incidence of toxic neuropathies is increasing with longer patients' life expectancy and represents a major factor in treatment limitation and the neurological side effects of HAART should be well identified by physicians.

摘要

周围神经病变(PN)是HIV感染患者最常见的神经学表现。即使在资源匮乏的国家,高效抗逆转录病毒疗法(HAART)的引入也对HIV相关神经病变的流行病学产生了重大影响。对2002年1月至2003年12月期间的HIV感染患者进行了为期2年的随访。PN根据踝反射或振动觉异常以及患者是否描述疼痛、感觉异常或麻木进行临床诊断。本研究未进行肌电图检查。在133例接受HAART治疗的HIV感染患者中,31例(23例女性和8例男性)平均年龄38.8岁的患者接受了PN随访。其中95.5%为HIV-1感染。根据抗逆转录病毒疗法的可用性,9例患者接受方案A治疗,包括拉米夫定+司他夫定+奈韦拉平,12例患者接受方案B治疗,包括司他夫定+拉米夫定+依非韦伦联合用药,10例患者接受方案C治疗,采用其他抗逆转录病毒疗法组合。平均CD4细胞计数为229.3/微升,60%的样本在诊断时CD4细胞计数<200。PN在开始HAART后5.6个月内出现,80%在治疗开始后不到3个月出现。16.1%的样本发现有灼足综合征。45.2%的多发性神经病变发生在HIV感染晚期(<200 CD4/微升)。PN的存在与CD4细胞计数减少和神经毒性抗逆转录病毒疗法有关。即使在资源匮乏的环境中,HAART的引入也改变了HIV感染的病程和预后。随着患者预期寿命的延长,毒性神经病变的发生率在增加,这是治疗受限的一个主要因素,医生应充分认识到HAART的神经学副作用。

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