Health Sciences International, University of California, San Diego, San Diego, CA.
Department of Psychiatry, University of California, La Jolla, CA.
J Acquir Immune Defic Syndr. 2019 Apr 15;80(5):568-573. doi: 10.1097/QAI.0000000000001953.
Medical comorbidities accumulate in older persons living with HIV (PLWH), causing disability and reduced quality of life. Sensory neuropathy and polypharmacy may contribute to balance difficulties and falls. The contribution of neuropathy is understudied.
To evaluate the contribution of chronic distal sensory polyneuropathy (cDSPN) to balance disturbances among PLWH.
Ambulatory PLWH and HIV- adults (N = 3379) were prospectively studied. All participants underwent a neurologic examination to document objective abnormality diagnostic of cDSPN and reported neuropathy symptoms including pain, paresthesias, and numbness. Participants provided detailed information regarding balance disturbance and falls over the previous 10 years. Balance disturbances were coded as minimal or none and mild-to-moderate. Covariates included age, HIV disease, and treatment characteristics and medications (sedatives, opioids, and antihypertensives).
Eleven percent of participants reported balance disturbances at some time during the last 10 years; the rate in PLWH participants exceeding that for HIV- [odds ratio 2.59, 95% confidence interval: 1.85 to 3.64]. Fifty-two percent met criteria for cDSPN. Balance problems were more common in those with cDSPN [odds ratio = 3.3 (2.6-4.3)]. Adjusting for relevant covariates, balance disturbances attributable to cDSPN were more frequent among HIV+ than HIV- (interaction P = 0.001). Among individuals with cDSPN, older participants were much more likely to report balance disturbances than younger ones.
cDSPN contributes to balance problems in PLWH. Assessments of cDSPN in older PLWH should be a clinical priority to identify those at risk and to aid in fall prevention and the ensuing consequences, including bone fractures, subdural hematoma, hospital admissions, and fatal injury.
患有 HIV 的老年人（PLWH）中会积累多种医学合并症，导致残疾和生活质量下降。周围神经病变和多种药物治疗可能导致平衡困难和跌倒。周围神经病变的作用尚未得到充分研究。
评估慢性远端感觉性多发性神经病（cDSPN）对 PLWH 平衡障碍的影响。
前瞻性研究了 3379 名有活动能力的 PLWH 和 HIV-成人。所有参与者都接受了神经系统检查，以记录客观异常，诊断为 cDSPN，并报告了包括疼痛、感觉异常和麻木在内的周围神经病变症状。参与者提供了关于过去 10 年中平衡障碍和跌倒的详细信息。平衡障碍被编码为轻度或无，或轻至中度。协变量包括年龄、HIV 疾病和治疗特征以及药物（镇静剂、阿片类药物和降压药）。
11%的参与者在过去 10 年中的某个时间报告了平衡障碍；PLWH 参与者的发生率高于 HIV-参与者[比值比 2.59，95%置信区间：1.85 至 3.64]。52%的人符合 cDSPN 的标准。有 cDSPN 的人更容易出现平衡问题[比值比=3.3（2.6-4.3）]。调整相关协变量后，cDSPN 导致的平衡障碍在 HIV+患者中比 HIV-患者更常见（交互 P=0.001）。在患有 cDSPN 的个体中，年龄较大的参与者比年龄较小的参与者更有可能报告平衡障碍。
cDSPN 导致 PLWH 出现平衡问题。在年龄较大的 PLWH 中评估 cDSPN 应该是临床重点，以识别有风险的人群，并帮助预防跌倒及其后续后果，包括骨折、硬膜下血肿、住院和致命伤害。
