Substance abuse increases the risk of neuropathy in an HIV-infected cohort

Department of Neurology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1052, New York, New York 10029, USA.
Muscle & Nerve (Impact Factor: 2.28). 04/2012; 45(4):471-6. DOI: 10.1002/mus.23231
Source: PubMed


Human immunodeficiency virus (HIV)-infected patients commonly develop distal symmetric polyneuropathy (DSP). Age, ethnicity, and toxic exposures may influence the risk. In this study we examined the association between substance use, antiretrovirals, ethnicity, and incident neuropathy in an HIV-infected cohort.
Data were obtained from the National NeuroAIDS Tissue Consortium (NNTC), an ongoing, prospective cohort started in 1998. Cox proportional hazards models were used to examine the association of substance use, demographics, neurotoxic antiretrovirals, and laboratory parameters with incident neuropathy in 636 participants who were neuropathy-free at baseline.
The cumulative incidence of DSP was 41%. Substance use (P = 0.04), number of substances used (P = 0.04), and longer duration of HIV infection (P = 0.05) were associated with incident DSP, but demographic factors, use of neurotoxic antiretrovirals, and laboratory parameters were not.
Substance use and longer duration of HIV infection are risk factors for DSP in HIV-infected patients. Use of multiple substances may be particularly risky.

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    • "The neuropathology, HIV-associated neurocognitive disorders, and distal symmetric polyneuropathy associated with HIV-1 infection have all been reported to be exacerbated by opiate drug use (Anthony et al., 2008; Anthony et al., 2005; Bell et al., 2006; Bell et al., 1998; Byrd et al., 2011; Robinson-Papp et al., 2012). Moreover, polymorphisms in the μopioid receptor (MOR) gene (OPRM1) have been suggested to alter the severity of HIV-1 infection and individual responsiveness to combination antiretroviral therapy (Proudnikov et al., 2012). "
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    • "HIV-associated distal symmetric polyneuropathy (HIV- DSP) is a common complication of HIV, and its symptoms include pain, paresthesias and numbness, usually beginning symmetrically in the feet [1] [2]. Recent publications have documented the continued high prevalence of HIV-DSP and its impact on quality of life. "
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    ABSTRACT: A woman with a seventeen-year history of HIV infection on effective antiretroviral therapy presented with signs and symptoms of distal symmetric polyneuropathy (DSP). She developed significant side effects (dizziness, nausea, edema) with medications for pain management. Chart review revealed a history of similar intolerance to multiple antiretrovirals, which was not explained by known cardiac or gastrointestinal disease or psychological factors. Specialized testing re-vealed the presence of an autonomic neuropathy, which provided an explanation for her medication intolerance. The patient was educated on the symptoms of autonomic neuropathy and its relationship to DSP and subsequent symptom-matic medications were initiated at the lowest possible doses. Although symptom management remained challenging, the patient exhibited lower frustration and greater acceptance of medication trials. Review of 168 advanced stage HIV infected individuals demonstrated that 81% experienced at least one, and 33% three or more, symptoms potentially at-tributable to autonomic neuropathy. Potentially autonomic symptoms were significantly associated with the presence of symptomatic DSP. Autonomic neuropathy is difficult to diagnose without specialized testing, as its symptoms are non-specific and overlap with a large number of somatic disorders. The high prevalence of autonomic-type symptoms in chronic HIV, and their association with peripheral neuropathy, may warrant further investigation of the potential for autonomic dysfunction in individuals with HIV-related symptomatic DSP.
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