Cherry C L, Affandi J S, Imran D, Yunihastuti E, Smyth K, Vanar S, Kamarulzaman A, Price P
Burnet Institute, Monash University, and The Alfred Hospital, Melbourne, Australia.
Neurology. 2009 Jul 28;73(4):315-20. doi: 10.1212/WNL.0b013e3181af7a22.
Sensory neuropathy is a common problem in HIV-infected patients and is the dose-limiting toxicity of stavudine. Affordable methods of predicting neuropathy risk are needed to guide prescribing in countries where some use of stavudine remains an economic necessity. We therefore aimed to identify factors predictive of neuropathy risk before antiretroviral use.
A total of 294 patients attending clinics in Melbourne, Kuala Lumpur, and Jakarta were enrolled in a cross-sectional neuropathy screening program in 2006. Neuropathy was defined by the presence of symptoms and signs on the AIDS Clinical Trials Group Brief Peripheral Neuropathy Screen. Demographic, laboratory, and treatment details were considered as possible risk factors for neuropathy. The role of patient demographics in predicting stavudine neuropathy were then assessed in 181 patients who reported that they were free of neuropathy symptoms when first prescribed this drug.
The prevalence of neuropathy was 42% in Melbourne (n = 100), 19% in Kuala Lumpur (n = 98), and 34% in Jakarta (n = 96). In addition to treatment exposures, increasing age (p = 0.002) and height (p = 0.001) were independently associated with neuropathy. Age and height cutoffs of > or=170 cm or > or =40 years predicted neuropathy. Among 181 patients who were asymptomatic before stavudine exposure, the risk of neuropathy following stavudine was 20% in younger, shorter patients, compared with 66% in older, taller individuals.
Stavudine neuropathy risk increases with patient age and height. Prioritizing older and taller patients for alternative agents would be an inexpensive strategy to reduce neuropathy rates in countries where the burden of HIV disease limits treatment options.
感觉神经病变是HIV感染患者的常见问题，也是司他夫定的剂量限制性毒性。在一些地区，司他夫定的使用仍出于经济需要，因此需要经济实惠的方法来预测神经病变风险，以指导用药。我们旨在确定在开始抗逆转录病毒治疗前可预测神经病变风险的因素。
2006年，共有294名在墨尔本、吉隆坡和雅加达诊所就诊的患者参加了一项横断面神经病变筛查项目。神经病变通过艾滋病临床试验组简易外周神经病变筛查中的症状和体征来定义。人口统计学、实验室和治疗细节被视为神经病变的可能危险因素。随后，在181名首次服用该药时报告无神经病变症状的患者中，评估了患者人口统计学因素在预测司他夫定所致神经病变中的作用。
墨尔本（n = 100）的神经病变患病率为42%，吉隆坡（n = 98）为19%，雅加达（n = 96）为34%。除治疗暴露外，年龄增加（p = 0.002）和身高增加（p = 0.001）与神经病变独立相关。年龄≥40岁或身高≥170 cm可预测神经病变。在司他夫定暴露前无症状的181名患者中，年轻、矮小患者服用司他夫定后发生神经病变的风险为20%，而年长、高大患者为66%。
司他夫定所致神经病变风险随患者年龄和身高增加而升高。在HIV疾病负担限制治疗选择的国家，优先为年长和高大患者选用替代药物将是降低神经病变发生率的一种经济策略。
