Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana

Abstract

Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38–10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26–0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36–1.83 and aOR = 2.17; 95% CI 0.93–5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS’ quality of life.Electronic supplementary materialThe online version of this article (10.1007/s13365-019-00743-0) contains supplementary material, which is available to authorized users.

Cardiovascular risk factors among patients with human immunodeficiency viral infection at a tertiary hospital in Ghana: a cross-sectional study

“…Patients were recruited from the adult HIV outpatient clinic at the infectious disease unit, KBTH. Korle Bu Teaching Hospital is the largest tertiary hospital in Ghana and has more than 2000 bed capacity and an outpatient department attendance of over 350,000 in 2016 [ 19 ]. At the time this study was conducted, about 19,000 people living with HIV (PLHIV) was attending the infectious disease unit.…”

“…None of the patients enrolled for this study declined consent. Details of the sample size determination has been provided elsewhere [ 19 ].…”

“…Measures: HIV diagnosis was made at the infectious unit by antibody detection on blood samples followed by laboratory confirmation using the OraQuick test according to the Ghana National AIDS Control Programme guidelines [ 19 ]. A participant was declared positive for HIV if both tests were positive.…”

“…Ethical considerations: ethical clearance and permission was sought and approved by the Ethical and Protocol Review Committee of the University of Ghana Medical School, and the Protocol Identification Number was MS-Et/M.9-P 5.7/2012-13 [ 19 ]. Respondents were informed about the objectives of the study, and written informed consent was obtained from all participating individuals before the commencement of the study.…”

Higher iron stores and the HFE 187C>G variant delay onset of peripheral neuropathy during combination antiretroviral therapy

“…HIV-related neuropathy and neuropathic pain are continuing challenges in HIV clinics worldwide, especially in settings where second-line cART is in use [8][9][10]. Stavudine has still been used in some low-resource settings, due to its lower cost and availability, though its use has declined [11][12][13][14][15][16][17]. It should also be noted that some studies have linked protease inhibitors such as indinavir to increased risk of HIV sensory neuropathy [9,18,19].…”