Ellis Ronald J, Rosario Debralee, Clifford David B, McArthur Justin C, Simpson David, Alexander Terry, Gelman Benjamin B, Vaida Florin, Collier Ann, Marra Christina M, Ances Beau, Atkinson J Hampton, Dworkin Robert H, Morgello Susan, Grant Igor
HIV Neurobehavioral Research Center, Department of Neurosciences, University of California, San Diego, San Diego, CA 92103, USA.
Arch Neurol. 2010 May;67(5):552-8. doi: 10.1001/archneurol.2010.76.
To provide updated estimates of the prevalence and clinical impact of human immunodeficiency virus-associated sensory neuropathy (HIV-SN) and neuropathic pain due to HIV-SN in the combination antiretroviral therapy (CART) era.
Prospective, cross-sectional analysis. Clinical correlates for HIV-SN and neuropathic pain, including age, exposure to CART, CD4 levels, plasma viral load, hepatitis C virus infection, and alcohol use disorders, were evaluated in univariate and multivariate models.
Six US academic medical centers.
One thousand five hundred thirty-nine HIV-infected individuals enrolled in the CNS (Central Nervous System) HIV Anti-Retroviral Therapy Effects Research study.
The presence of HIV-SN, defined by 1 or more clinical signs (diminished vibration or sharp sensation in the legs and feet; reduced ankle reflexes) in a distal, symmetrical pattern. Neuropathic pain was defined as aching, stabbing, or burning in a similar distribution. The effect on quality of life was assessed with the Medical Outcomes Study HIV Health Survey.
We found HIV-SN in 881 participants. Of these, 38.0% reported neuropathic pain. Neuropathic pain was significantly associated with disability in daily activities, unemployment, and reduced quality of life. Risk factors for HIV-SN after adjustment were advancing age (odds ratio, 2.1 [95% confidence interval, 1.8-2.5] per 10 years), lower CD4 nadir (1.2 [1.1-1.2] per 100-cell decrease), current CART use (1.6 [1.3-2.8]), and past "D-drug" use (specific dideoxynucleoside analogue antiretrovirals) (2.0 [1.3-2.6]). Risk factors for neuropathic pain were past D-drug use and higher CD4 nadir.
Neuropathic pain and HIV-SN remain prevalent, causing substantial disability and reduced quality of life even with successful CART. The clinical correlates of HIV-SN have changed with the evolution of treatment. These findings argue for redoubled efforts to determine HIV-SN pathogenesis and the development of symptomatic and neuroregenerative therapies.
提供在联合抗逆转录病毒治疗（CART）时代，人类免疫缺陷病毒相关感觉神经病变（HIV-SN）的患病率及临床影响，以及由HIV-SN导致的神经性疼痛的最新评估数据。
前瞻性横断面分析。在单变量和多变量模型中评估HIV-SN和神经性疼痛的临床相关因素，包括年龄、CART治疗暴露情况、CD4水平、血浆病毒载量、丙型肝炎病毒感染及酒精使用障碍。
美国六个学术医疗中心。
1539名参加中枢神经系统（CNS）HIV抗逆转录病毒治疗效果研究的HIV感染者。
HIV-SN的存在，定义为在远端呈对称性分布，出现1种或更多临床体征（腿部和脚部振动或刺痛感减弱；踝反射减弱）。神经性疼痛定义为在类似分布区域出现疼痛、刺痛或灼痛。使用医学结局研究HIV健康调查评估对生活质量的影响。
我们在881名参与者中发现了HIV-SN。其中，38.0%报告有神经性疼痛。神经性疼痛与日常活动能力丧失、失业及生活质量下降显著相关。调整后的HIV-SN危险因素包括年龄增长（每10年比值比为2.1[95%置信区间为1.8 - 2.5]）、最低CD4水平降低（每降低100个细胞为1.2[1.1 - 1.2]）、当前使用CART（1.6[1.3 - 2.8]）及过去使用“D类药物”（特定双脱氧核苷类似物抗逆转录病毒药物）（2.0[1.3 - 2.6]）。神经性疼痛的危险因素为过去使用D类药物及较高的最低CD4水平。
即使在CART治疗成功的情况下，神经性疼痛和HIV-SN仍然普遍存在，导致严重的功能障碍和生活质量下降。随着治疗的发展，HIV-SN的临床相关因素发生了变化。这些发现表明需要加倍努力确定HIV-SN的发病机制，并开发对症治疗和神经再生疗法。
