Prevalent neuropathy in a cohort of HIV-infected Kenyan sex workers using antiretroviral drugs

Abstract

Introduction: Several risk factors including stavudine and age have been strongly associated with polyneuropathy. However, conflicting data exist
on height as an independent risk factor in polyneuropathy. The objective of this study is to exclude height as an independent polyneuropathy risk
factor in a cohort of human immunodeficiency virus (HIV)-infected Kenyan sex workers. Methods: This was an analysis of prospectively collected
data of treatment-naive subjects initiating either stavudine or tenofovir disoproxil fumarate or zidovudine-based antiretroviral therapy (ART)
regimens from January 2008 to August 2012. Polyneuropathy was characterised as burning sensation, numbness, or dysesthesia. The study used
arithmetic means of weight (kg) and height (cm) measured in duplicates using calibrated scales. Results: After exclusion of duplicate data sets
and un-confirmed cases of polyneuropathy, the study identified 212 patients without polyneuropathy, 14 pre-ART and 94 post-ART related
polyneuropathy cases. Polyneuropathy cases were older but did not differ in demographic, clinical and laboratory parameters at baseline. There
was a significant difference in first-line ART regimens with more patients on tenofovir disoproxil fumarate in the post-ART group (p=0.017).
Conclusion: Polyneuropathy is a common disorder among HIV-infected Kenyan sex workers. These data cannot support the postulated increased
risk by height after matching for gender and ART duration. Though stavudine is associated with polyneuropathy, in this study many patients
previously not exposed to stavudine developed polyneuropathy. This suggests the involvement of unknown risk factors such as genetic and
metabolite differences in the development of polyneuropathy.