HIV-associated painful neuropathy: where are we?

ABSTRACT

Background: After the advent of combination antiretroviral therapy, infection with the human immunodeficiency virus (HIV) ceased to be a devastating disease, but sensory neuropathy resulting from the permanence of the virus and the side effects of treatment have worsened the morbidities of these patients. Objective: To investigate the quality of life of 64 HIV-positive patients: 24 with painful neuropathy (case group) and 40 without painful neuropathy (control group). The impact of other factors on quality of life was also assessed. Methods To assess painful neuropathy, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, Douleur Neuropathique 4 (DN4) questions and Neuropathy Disability Score (NDS) were used. The Short Form Health Survey (SF-36) scale was used to assess quality of life. Factors related or unrelated to HIV were obtained through the medical history and analysis on medical records. Results: The quality of life of patients with neuropathic pain was worse in six of the eight domains of the SF-36 scale. The number of clinical manifestations related to HIV, length of time with detectable viral load since diagnosis, length of time since the diagnosis of HIV infection and length of time of HAART use had a negative impact on quality of life. Higher levels of CD4, education and family income had a positive impact. Conclusions: Painful neuropathy related to HIV is a factor that worsens the quality of life of patients infected with this virus and should be included in the clinical evaluation.

RESUMO

Antecedentes: Após o advento da terapia antirretroviral combinada a infecção pelo vírus da imunodeficiência humana (HIV) deixou de ser uma doença devastadora, porém a neuropatia sensitiva consequente à permanência do vírus e ao efeito colateral do tratamento piora a morbidade desses pacientes. Objetivo: Investigar a qualidade de vida de 64 pacientes com HIV, 24 com neuropatia dolorosa (grupo caso) e 40 sem neuropatia dolorosa (grupo controle). Avaliou-se também o impacto de outros fatores relacionados e não relacionados ao HIV na qualidade de vida. Métodos: Para avaliação da neuropatia dolorosa foram utilizadas as escalas Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Douleur Neuropathique 4 (DN4) e Escore de Comprometimento Neuropático (ECN). Para avaliação da qualidade de vida foi utilizada a escala Short Form Health Survey (SF-36). Fatores relacionados e não relacionados ao HIV foram obtidos através da anamnese e análise de prontuário. Resultados: A qualidade de vida dos pacientes com dor neuropática foi pior em 6 dos 8 domínios da escala SF-36. O número de manifestações clínicas relacionadas ao HIV, tempo de carga viral detectável desde o diagnóstico, tempo de diagnóstico da infecção pelo vírus e tempo de uso de TARVC impactaram negativamente na qualidade de vida. Maior nível de CD4, da escolaridade e da renda familiar impactaram positivamente. Conclusões: A neuropatia dolorosa relacionada ao HIV é fator de piora da qualidade de vida dos pacientes infectados por esse vírus devendo ser incluída na avaliação clínica desses pacientes.

Keywords:

Morbidity - HIV - Quality of Life

Palavras-chave:

Morbidade - HIV - Qualidade de Vida

Authors’ contributions:

KLP: investigation, methodology, writing original draft, writing review and editing; MSMB, TAMB: investigation; BLP, CCBP: investigation, writing review and editing; OJMN: investigation, methodology, supervision, writing review and editing.

Publication History

Received: 19 June 2021

Accepted: 05 October 2021

Article published online:
06 February 2023

• REFERENCES

• 1 Ministério da Saúde. Boletim Epidemiologico HIV Aids 2017. Brasília (DF): Secretaria de Vigilância em Saúde; 2018. 64.
• 2 Boissé L, Gill MJ, Power C. HIV infection of the central nervous system: clinical features and neuropathogenesis. Neurol Clin 2008; 26 (03) 799-819 https://doi.org/10.1016/j.ncl.2008.04.002
• 3 Morgello S, Estanislao L, Simpson D, Geraci A, DiRocco A, Gerits P. et al. HIV-associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy: the Manhattan HIV Brain Bank. Arch Neurol 2004; 61 (04) 546-551 https://doi.org/10.1001/archneur.61.4.546
• 4 Chen H, Clifford DB, Deng L, Wu K, Lee AJ, Bosch RJ. et al. Peripheral neuropathy in ART-experienced patients: prevalence and risk factors. J Neurovirol 2013; 19 (06) 557-564 https://doi.org/10.1007/s13365-013-0216-4
• 5 Prior DE, Song N, Cohen JA. Neuromuscular diseases associated with Human Immunodeficiency Virus infection. J Neurol Sci 2018; 387: 27-36 https://doi.org/10.1016/j.jns.2018.01.016
• 6 Zanetti C, Manzano GM, Gabbai AA. The frequency of peripheral neuropathy in a group of HIV positive patients in Brazil. Arq Neuropsiquiatr 2004; 62(2A) 253-256 https://doi.org/10.1590/s0004-282x2004000200012
• 7 Simpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B. et al. HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology 2006; 66 (11) 1679-1687 https://doi.org/10.1212/01.wnl.0000218303.48113.5d
• 8 Benevides MLACSE, Beduschi Filho S, Debona R, Bergamaschi ENC, Nunes JC. Prevalence of Peripheral Neuropathy and associated factors in HIV-infected patients. J Neurol Sci 2017; 375: 316-320 https://doi.org/10.1016/j.jns.2017.02.011
• 9 Miners A, Phillips A, Kreif N, Rodger A, Speakman A, Fisher M. et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV 2014; 1 (01) e32-40 https://doi.org/10.1016/S2352-3018(14)70018-9
• 10 Surur AS, Teni FS, Wale W, Ayalew Y, Tesfaye B. Health related quality of life of HIV/AIDS patients on highly active anti-retoviral therapy at a university referral hospital in Ethiopia. BMC Health Serv Res 2017; 17 (01) 737 https://doi.org/10.1186/s12913-017-2714-1
• 11 Gebremichael DY, Hadush KT, Kebede EM, Zegeye RT. Gender difference in health related quality of life and associated factors among people living with HIV/AIDS attending anti-retroviral therapy at public health facilities, western Ethiopia: comparative cross sectional study. BMC Public Health 2018; 18 (01) 537 https://doi.org/10.1186/s12889-018-5474-x
• 12 Degroote S, Vogelaers DP, Vermeir P, Mariman A, De Rick A, Van Der Gucht B. et al. Socio-economic, behavioural, (neuro)psychological and clinical determinants of HRQoL in people living with HIV in Belgium: a pilot study. J Int AIDS Soc 2013; 16 (01) 18643 https://doi.org/10.7448/IAS.16.1.18643
• 13 Brucki SMD, Nitrin R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003; 61(3B) 777-781 https://doi.org/10.1590/S0004-282X2003000500014
• 14 Joe KK, Manyonga ET, Mwembo AN, Stani W, Kavulu RM, Lukusa MV. Peripheral neuropathy and quality of life of adults living with HIV/AIDS in Lubumbashi, Democratic Republic of Congo. J Infect Dis Treat 2016; 2 (02) 19 https://doi.org/10.21767/2472-1093.100024
• 15 Kaku M, Simpson DM. HIV neuropathy Curr Opin HIV AIDS. 2014; 9 (06) 521-526 https://doi.org/10.1097/COH.20210079202100790103
• 16 Pettersen JA, Jones G, Worthington C, Krentz HB, Keppler OT, Hoke A. et al. Sensory neuropathy in human immunodeficiency virus/acquired immunodeficiency syndrome patients: protease inhibitor-mediated neurotoxicity. Ann Neurol 2006; 59 (05) 816-824 https://doi.org/10.1002/ana.20816
• 17 Cherry CL, Affandi JS, Imran D, Yunihastuti E, Smyth K, Vanar S. et al. Age and height predict neuropathy risk in patients with HIV prescribed stavudine. Neurology 2009; 73 (04) 315-320 https://doi.org/10.1212/WNL.0b013e3181af7a22
• 18 Watters MR, Poff PW, Shiramizu BT, Holck PS, Fast KMS, Shikuma CM. et al. Symptomatic distal sensory polyneuropathy in HIV after age 50. Neurology 2004; 62 (08) 1378-1383 https://doi.org/10.1212/01.wnl.0000120622.91018.ea
• 19 Phillips TJC, Brown M, Ramirez JD, Perkins J, Woldeamanuel YW, De Williams ACC. et al. Sensory, psychological, and metabolic dysfunction in HIV-associated peripheral neuropathy: a cross-sectional deep profiling study. Pain 2014; 155 (09) 1846-1860 https://doi.org/10.1016/j.pain.2014.06.014
• 20 Tumusiime DK, Venter F, Musenge E, Stewart A. Prevalence of peripheral neuropathy and its associated demographic and health status characteristics, among people on antiretroviral therapy in Rwanda. BMC Public Health 2014; 14: 1306 https://doi.org/10.1186/1471-2458-14-1306
• 21 Robinson-Papp J, Sharma S, Simpson DM, Morgello S.. Autonomic dysfunction is common in HIV and associated with distal symmetric polyneuropathy. J Neurovirol 2013; 19 (02) 172-180 https://doi.org/10.1007/s13365-013-0160-3
• 22 Keltner JR, Fennema-Notestine C, Vaida F, Wang D, Franklin DR, Dworkin RH. et al. HIV-associated distal neuropathic pain is associated with smaller total cerebral cortical gray matter. J Neurovirol 2014; 20 (03) 209-218 https://doi.org/10.1007/s13365-014-0236-8
• 23 Navis A, Jiao J, George MC, Simpson D, Robinson-Papp J. Comorbid pain syndromes in HIV-associated peripheral neuropathy. Pain Med 2018; 19 (07) 1445-1450 https://doi.org/10.1093/pm/pnx129
• 24 Hays RD, Cunningham WE, Sherbourne CD, Wilson IB, Wu AW, Cleary PD. et al. Health-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV cost and services utilization study. Am J Med 2000; 108 (09) 714-722 https://doi.org/10.1016/s0002-9343(00)00387-9
• 25 Jin Y, Liu Z, Wang X, Liu H, Ding G, Su Y. et al. A systematic review of cohort studies of the quality of life in HIV/AIDS patients after antiretroviral therapy. Int J STD AIDS 2014; 25 (11) 771-777 https://doi.org/10.1177/0956462414525769
• 26 Jia H, Uphold CR, Wu S, Chen GJ, Duncan PW. Predictors of changes in health-related quality of life among men with HIV infection in the HAART era. AIDS Patient Care STDS 2005; 19 (06) 395-405 https://doi.org/10.1089/apc.2005.19.395
• 27 Figuero LSB, Luque PB, Martín TP, Sagrado MG, Bouza JME. Assessment of factors influencing health-related quality of life in HIV-infected patients. HIV Med 2011; 12 (01) 22-30 https://doi.org/10.1111/j.1468-1293.2010.00844.x
• 28 O’Brien K, Tynan A-M, Nixon S, Glazier RH. Effects of progressive resistive exercise in adults living with HIV/AIDS: systematic review and meta-analysis of randomized trials. AIDS Care 2008; 20 (06) 631-653 https://doi.org/10.1080/09540120701661708
• 29 O’Brien KK, Tynan A-M, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis 2016; 16: 182 https://doi.org/10.1186/s12879-016-1478-2
• 30 Maharaj SS, Yakasai AM. Does a rehabilitation program of aerobic and progressive resisted exercises influence HIV-Induced distal neuropathic pain?. Am J Phys Med Rehabil 2018; 97 (05) 364-369 https://doi.org/10.1097/PHM.20210079202100790866
• 31 Mannheimer SB, Matts J, Telzak E, Chesney M, Child C, Wu AW. et al. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care 2005; 17 (01) 10-22 https://doi.org/10.1080/09540120412331305098