Prevalence and types of peripheral neuropathy in HIV infected patients on stavudine-based HAART regimen at Kenyatta National Hospital

Abstract

Introduction: Peripheral neuropathy, which is abnormal function and structure of peripheral motor, sensory and autonomic neurons is important drug associated toxicity with the nucleoside reverse transcriptase inhibitors, which are used as anti retroviral backbone in management of HIV/AIDS. The prevalence of peripheral neuropathy in patients on this class of antiretrovirals is unknown locally, especially with the up-scaling of ARV use where stavudine is a major backbone. Objectives: To determine the prevalence and types of peripheral neuropathy in HIV infected patients on stavudine-based regimen, and compare with those natve to antiretrovirals but eligible for HAART at KNH. Design: Cross sectional comparative study. Setting: Comprehensive care clinic of Kenyatta National Hospital Study population: Adults (>13 years) with HIV infection on stavudine-based regimen for a period of at least three months and those na"ive to antiretrovirals but eligible for HAART. The study targeted WHO ""IV HIV patients. Methods: Sixty four (64) patients with HIV infection, 32 on stavudine-based regimen for a period of at least three months and another 32 natve to antiretrovirals but eligible for HAART (32 of each group matched for age to the nearest 5 years, sex and CD4 category). Neurological history, examination and electrophysiological study were done for every patient. Results: The mean age for those patients on ARVs was 38.8 ± 6.4 years, range 24 - 50 years, while for the comparison group, the mean age was 38.4 ± 7.6 years, range 24 - 55 years, there being no statistically significant difference, p value of 0.93. Most patients (75% of the ones on treatment and 68.75% of the ones narve to treatment) were in WHO clinical stage 4. Their mean CD4+ cell count was 115.6 ± 53.9 (range 6 - 190) for those on ARVs and 123.6 ± 65.3 (range 12- 198) for the HAART naive group. There was no statistically significant difference, p value of 0.6. The mean duration of ARV use for the group on ARVs was 22.6 months, range 10 - 42 months.Fifteen patients (46.9%) on ARVs compared to eight patients (25%) of the naive group, were symptomatic for peripheral neuropathy (p value = 0.08). The most common symptoms in the two groups were burning sensation followed by paraesthesiae. The most common physical findings on neurological examination were impaired vibration perception sense followed by impaired proprioception in the natvs patients. Those on ARVs had most of the findings spread out with slight predominance of reduced tone and muscle power followed by impaired touch sensation.Twenty one (65.6%) patients on stavudine-based regimen had evidence of peripheral neuropathy as compared to eleven (34.4%) narve patients (p = 0.02). Patients on ARVs had Significantly more axon apathy at a p value of 0.05. The natve patients had predominant demyelination. Conclusion: Peripheral neuropathy predominantly, axon apathy is common in patients on stavudine-based regimen of antiretrovirals. The toxicity of stavudine-based antiretrovirals may limit the use of the regimen and reduce drug adherence.