Unhealthy behaviours for self-management of HIV-related peripheral neuropathy.
ABSTRACT The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.
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ABSTRACT: Sensory polyneuropathies are the most frequent neurological complication of human immunodeficiency virus (HIV) infection. Distal symmetric polyneuropathy (DSP), associated with HIV infection, is characterized by length-dependent axonal degeneration of sensory fibres. In rodent dorsal root ganglia (DRG) cultures, HIV viral envelope protein gp120 results in neurotoxicity and axonal degeneration. Since it is unknown whether the axonal degeneration is a consequence of neuronal death or whether it is due to a direct toxic effect on axons, we investigated gp120-induced axonal toxicity using compartmentalized cultures of sensory neurons. Our results show that gp120 causes neuronal apoptosis and axonal degeneration through two, independent and spatially separated mechanisms of action: (i) an indirect insult to cell bodies, requiring the presence of Schwann cells, results in neuronal apoptotic death and subsequent axonal degeneration; (ii) a direct, local toxicity exerted on axons through activation of mitochondrial caspase pathway that is independent of cell body. This local axonal toxicity is mediated through binding of gp120 to axonal chemokine receptors and can be prevented by chemokine receptor blockers. In conclusion, we propose a novel pathway of axonal degeneration mediated by gp120 that is dependent on local activation of caspases in the axon. This observation suggests that axonal protection is a relevant therapeutic target for HIV-associated sensory neuropathy. Furthermore, chemokine receptor inhibitors, which are currently being developed as HIV entry inhibitor drugs, may also have a therapeutic role in HIV-associated peripheral neuropathies by preventing axonal degeneration.Brain 06/2006; 129(Pt 5):1330-8. · 9.92 Impact Factor
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ABSTRACT: Symptom management for persons living with HIV/AIDS is recognized as an extremely important component of care management. This article reports on the continuing validation of the revised Sign and Symptom Check-List for Persons With HIV Disease (SSC-HIVrev). The initial validation study used a combined sample of 933 HIV-positive persons and concluded that the validity and reliability of the instrument were adequate to measure patients' self-report of HIV-related signs and symptoms. The revised scale includes items to measure gynecological-related symptoms and the impact of lipodystrophy (body fat redistribution) due to antiretroviral therapy on patients' symptom experience. The scale structure (factor analysis) and reliability estimates were recalculated in a new sample of 372 HIV-positive persons. Based on reviewing the clusters of items, factor loadings, reliability estimates, and clinical interpretability, an 11-factor solution was determined that explained 73.3% of the variance. Of the retained factors, 4 had eigenvalues less than 1, yet they explained significant amounts of variance in the rotated sums of squares loading (5.0%, 4.3%, 4.3%, and 3.6%, respectively), the reliability estimates were good, and the factors had clinical meaning. The revised scale (SSC-HIVrev) has three parts: Part 1 consists of 45 items that clustered into 11 factor scores along with a total score, with reliability estimates ranging from .76 to .91; Part 2 consists of 19 HIV-related symptoms that do not cluster into factor scores but may be of interest from a clinical perspective; and Part 3 consists of 8 items related to gynecological symptoms for women. These 8 items were submitted to a principal components factor analysis with varimax rotation (n = 118 HIV-positive women), and a 1-factor solution explained 71.8% of the variance, with a reliability estimate of .94. The psychometric properties of the SSC-HIVrev are presented.Journal of the Association of Nurses in AIDS Care 01/2001; · 1.09 Impact Factor
- The AIDS reader 08/2005; 15(7):349. · 0.61 Impact Factor