Harvard School of Public Health, 651 Huntington Avenue, Boston, MA 02115, USA.
AIDS. 2011 Apr 24;25(7):919-28. doi: 10.1097/QAD.0b013e328345889d.
To estimate neuropathic sign/symptom rates with initiation of combination antiretroviral therapy (cART) in HIV-infected ART-naive patients, and to investigate risk factors for: peripheral neuropathy and symptomatic peripheral neuropathy (SPN), recovery from peripheral neuropathy/SPN after neurotoxic ART (nART) discontinuation, and the absence of peripheral neuropathy/SPN while on nART.
AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trial participants who initiated cART in randomized trials for ART-naive patients were annually screened for symptoms/signs of peripheral neuropathy. ART use and disease characteristics were collected longitudinally.
Peripheral neuropathy was defined as at least mild loss of vibration sensation in both great toes or absent/hypoactive ankle reflexes bilaterally. SPN was defined as peripheral neuropathy and bilateral symptoms. Generalized estimating equation logistic regression was used to estimate associations.
Two thousand, one hundred and forty-one participants were followed from January 2000 to June 2007. Rates of peripheral neuropathy/SPN at 3 years were 32.1/8.6% despite 87.1% with HIV-1RNA 400 copies/ml or less and 70.3% with CD4 greater than 350 cells/μl. Associations with higher odds of peripheral neuropathy included older patient age and current nART use. Associations with higher odds of SPN included older patient age, nART use, and history of diabetes mellitus. Associations with lower odds of recovery after nART discontinuation included older patient age. Associations with higher odds of peripheral neuropathy while on nART included older patient age and current protease inhibitor use. Associations with higher odds of SPN while on nART included older patient age, history of diabetes, taller height, and protease inhibitor use.
Signs of peripheral neuropathy remain despite virologic/immunologic control but frequently occurs without symptoms. Aging is a risk factor for peripheral neuropathy/SPN.
评估 HIV 感染初治患者接受联合抗逆转录病毒治疗（cART）时出现周围神经病变体征/症状的发生率，并研究以下方面的危险因素：周围神经病和有症状的周围神经病（SPN）、停止神经毒性 ART（nART）后周围神经病/SPN 的恢复情况，以及在接受 nART 治疗时无周围神经病/SPN 的情况。
在针对初治患者的随机试验中接受 cART 的 AIDS 临床试验组（ACTG）纵向链接随机试验参与者，每年对周围神经病变的症状/体征进行筛查。ART 使用和疾病特征进行纵向收集。
周围神经病定义为双侧大脚趾振动觉至少轻度丧失或双侧踝反射消失/减弱。有症状的周围神经病定义为周围神经病和双侧症状。使用广义估计方程逻辑回归来估计关联。
从 2000 年 1 月至 2007 年 6 月，2141 名参与者得到随访。尽管有 87.1%的患者 HIV-1RNA<400 拷贝/ml，70.3%的患者 CD4>350 个/μl，但 3 年后周围神经病/SPN 的发生率仍为 32.1%/8.6%。与更高的周围神经病几率相关的因素包括患者年龄较大和当前 nART 的使用。与 SPN 几率较高相关的因素包括患者年龄较大、nART 的使用以及糖尿病病史。与 nART 停药后恢复几率较低相关的因素包括患者年龄较大。与接受 nART 治疗时发生周围神经病几率较高相关的因素包括患者年龄较大和当前使用蛋白酶抑制剂。与接受 nART 治疗时发生 SPN 几率较高相关的因素包括患者年龄较大、糖尿病史、较高的身高和蛋白酶抑制剂的使用。
尽管病毒学/免疫学控制，但仍存在周围神经病变的体征，且经常在无症状的情况下发生。衰老为周围神经病/SPN 的危险因素。
