International Neurologic & Psychiatric Epidemiology Program, Department of Neurology & Ophthalmology, Michigan State University, 909 West Fee Road, Room 324, East Lansing, MI 48824, USA; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia, Nationalist Road, P.O. Box 50110, Lusaka, Zambia.
Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia, Nationalist Road, P.O. Box 50110, Lusaka, Zambia.
J Neurol Sci. 2018 May 15;388:61-69. doi: 10.1016/j.jns.2018.02.035. Epub 2018 Feb 22.
Non-antiretroviral (ART) drug exposures and poor nutrition may be important modifiable risk factors for distal symmetric polyneuropathies (DSP) in sub-Saharan Africa.
We conducted a cross-sectional study of DSP prevalence and factors associated with DSP among clinic attendees in urban and rural Zambia. All participants underwent neurologist-performed examination. Laboratory investigations seeking comorbid risk factors for DSP were performed for DSP cases.
We identified 31/137 (22.6%) HIV+ and 21/177 (11.9%) HIV- DSP cases. DSP prevalence did not differ by urbanicity, although rural participants were significantly more likely to have one asymptomatic DSP sign. Low dietary diversity, history of syphilis, history of tuberculosis, and prior metronidazole and ciprofloxacin use were associated with DSP amongst HIV+ cases, while age and education were associated with DSP in HIV- participants (all p-values < 0·05). In a multivariate logistic regression model, HIV (p = 0·0001) and age (p < 0·0001), and ciprofloxacin exposure (p = 0·01) remained independently associated with DSP. While diabetes was rare, supoptimal micronutrients levels were common among DSP cases regardless of HIV status.
While HIV infection is strongly associated with DSP in Zambia, history of non-ART drug exposures and low dietary diversity are also important determinants of DSP in HIV+ individuals. Treatable micronutrient deficiencies were common.
在撒哈拉以南非洲，非抗逆转录病毒（ART）药物暴露和营养不良可能是导致远端对称性多发性神经病（DSP）的重要可改变危险因素。
我们对赞比亚城乡诊所就诊者中 DSP 的流行情况以及与 DSP 相关的因素进行了一项横断面研究。所有参与者均接受了神经病学家进行的检查。对 DSP 病例进行了实验室检查，以寻找 DSP 的合并风险因素。
我们共发现 31/137（22.6%）例 HIV+和 21/177（11.9%）例 HIV- DSP 病例。DSP 的流行率与城市或农村地区无关，尽管农村参与者无症状 DSP 体征的比例明显更高。低饮食多样性、梅毒史、结核病史、先前使用甲硝唑和环丙沙星与 HIV+病例的 DSP 相关，而年龄和教育程度与 HIV-参与者的 DSP 相关（所有 p 值均<0·05）。在多变量逻辑回归模型中，HIV（p=0·0001）和年龄（p<0·0001）以及环丙沙星暴露（p=0·01）与 DSP 独立相关。尽管糖尿病较为少见，但无论 HIV 状态如何，DSP 病例的微量营养素水平均不理想。
尽管在赞比亚，HIV 感染与 DSP 密切相关，但非 ART 药物暴露史和低饮食多样性也是 HIV 阳性个体 DSP 的重要决定因素。常见可治疗的微量营养素缺乏。
