HIV neuropathy in South Africans: Frequency, characteristics, and risk factors
The purpose was to estimate the frequency, characteristics, and risk factors of HIV‐associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community‐based clinic. In a cross‐sectional study, neuropathy status was determined in 598 HIV‐infected adults using validated...
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| Published in | Muscle & nerve Vol. 41; no. 5; pp. 599 - 606 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken
Wiley Subscription Services, Inc., A Wiley Company
01.05.2010
Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0148-639X 1097-4598 1097-4598 |
| DOI | 10.1002/mus.21535 |
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| Abstract | The purpose was to estimate the frequency, characteristics, and risk factors of HIV‐associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community‐based clinic. In a cross‐sectional study, neuropathy status was determined in 598 HIV‐infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0–2.9), age (per 10 year increment) (OR 1.7, 1.4–2.2), and prior TB (OR 2.0, 1.3–3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV‐infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine‐containing regimens in older subjects, especially with a history of prior TB infection. Muscle Nerve, 2010 |
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| AbstractList | The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection. The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection. Muscle Nerve, 2010. The purpose was to estimate the frequency, characteristics, and risk factors of HIV‐associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community‐based clinic. In a cross‐sectional study, neuropathy status was determined in 598 HIV‐infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0–2.9), age (per 10 year increment) (OR 1.7, 1.4–2.2), and prior TB (OR 2.0, 1.3–3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV‐infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine‐containing regimens in older subjects, especially with a history of prior TB infection. Muscle Nerve, 2010 The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection.The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection. |
| Author | Harrison, Taylor B. Dave, Joel A. Heckmann, Jeannine M. Maritz, Jean Levitt, Naomi S. Benatar, Michael Badri, Motasim |
| Author_xml | – sequence: 1 givenname: Jean surname: Maritz fullname: Maritz, Jean organization: Division of Neurology, Department of Medicine, University of Cape Town, Observatory, 7925, Cape Town, South Africa – sequence: 2 givenname: Michael surname: Benatar fullname: Benatar, Michael organization: Department of Neurology, Emory University, Atlanta, Georgia, USA – sequence: 3 givenname: Joel A. surname: Dave fullname: Dave, Joel A. organization: Division of Endocrinology, Department of Medicine, University of Cape Town, South Africa – sequence: 4 givenname: Taylor B. surname: Harrison fullname: Harrison, Taylor B. organization: Department of Neurology, Emory University, Atlanta, Georgia, USA – sequence: 5 givenname: Motasim surname: Badri fullname: Badri, Motasim organization: Department of Medicine, University of Cape Town, South Africa – sequence: 6 givenname: Naomi S. surname: Levitt fullname: Levitt, Naomi S. organization: Division of Endocrinology, Department of Medicine, University of Cape Town, South Africa – sequence: 7 givenname: Jeannine M. surname: Heckmann fullname: Heckmann, Jeannine M. email: jeanine.heckmann@uct.ac.za organization: Division of Neurology, Department of Medicine, University of Cape Town, Observatory, 7925, Cape Town, South Africa |
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| Keywords | Sensitivity disorder Questionnaire nucleoside reverse transcriptase inhibitors Paresthesia Mycobacterial infection Neuropathy Polyneuropathy antiretroviral toxic neuropathy distal sensory polyneuropathy Pain Peripheral nerve disease Neurological disorder Human Immunopathology Nervous system diseases Africa AIDS Immune deficiency Infection Frequency characteristic Tuberculosis HIV Viral disease Bacteriosis Sign Avoidance |
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| References | Browne MJ, Mayer KH, Chafee SB, Dudley MN, Posner MR, Steinberg SM, et al. 2',3'-Didehydro-3'-deoxythymidine (d4T) in patients with AIDS or AIDS-related complex: a phase I trial. J Infect Dis 1993; 167: 21-29. Cherry CL, Wesselingh SL, Lal L, McArthur JC. Evaluation of a clinical screening tool for HIV-associated sensory neuropathies. Neurology 2005; 65: 1778-1781. Morgello S, Estanislao L, Simpson D, Geraci A, Di Rocco 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; 546-551. Cornblath DR, Chaudry V, Carter K, Lee D, Seysedadr M, Miernicki M, et al. Total neuropathy score: validation and reliability study. Neurology 1999; 53: 1660-1664. Wright E, Brew B, Araywichanont A, Robertson K, Samintharapanya K, Kongsaengdao S, et al. Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region. Neurology 2008; 71: 50-56. Schifitto G, McDermott MP, McArthur JC, Marder K, Sacktor N, Epstein L, et al. Incidence of and risk factors for HIV-associated distal sensory polyneuropathy. Neurology 2002; 58: 1764-1768. 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: 816-824. Villamor E, Mugusi F, Urassa W, Bosch RJ, Saathoff E, Matsumoto K, et al. A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis. J Infect Dis 2008; 197: 1499-1505. Pandya R, Krentz HB, Gill MJ, Power C. HIV-related neurological syndromes reduce health-related quality of life. Can J Neurol Sci 2005; 32: 201-204. Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of Adult AIDS Clinical Trials Group (AACTG). AIDS Care 2000; 12: 255-266. American Diabetic Association position statement: standards of medical care in diabetes-2009. Diabetes Care 2009; 32( Suppl 1): S13-61. Affandi JS, Price P, Imran D, Yunihastuti E, Djauzi S, Cherry CL. Can we predict neuropathy risk before stavudine prescription in a resource-limited setting?. AIDS Res Hum Retroviruses 2008; 24: 1281-1284. Cherry CL, Skolasky RL, Lal L, Creighton J, Hauer P, Raman SP, et al. Antiretroviral use and other risks for HIV-associated neuropathies in an international cohort. Neurology 2006; 66: 867-873. Hung CF, Gibson SA, Letendre SL, Lonergan JT, Marquie-Beck JA, Vaida F, et al. Impact of long-term treatment with neurotoxic dideoxynucleosides antiretrovirals: implications for clinical care in resource-limited settings. HIV Med 2008; 9: 731-737. Smyth K, Affandi JS, McArthur JC, Bowtell-Harris C, Mijch AM, Watson K, et al. Prevalence of and risk factors for HIV-associated neuropathy in Melbourne, Australia 1993-2006. HIV Med 2007; 8: 367-373. Lawn SD, Myer L, Bekker L-G, Wood R. Burden of tuberculosis in an antiretroviral treatment programme in sub-Saharan Africa: impact on treatment outcomes and implications for tuberculosis control. AIDS 2006; 20: 1605-1612. Sithinamsuwan P, Punthanamongkol S, Valcour V, Onsanit S, Nidhinandana S, Thitivichianlert S, et al. Frequency and characteristics of HIV-associated sensory neuropathy among HIV patients in Bangkok, Thailand. J Acquir Immune Defic Syndr 2008; 49: 456-458. 2002; 58 2004; 61 2006; 20 2009; 32 2001 2000; 12 2006; 66 2008; 49 2006; 59 2007; 8 2009 2008; 9 2006 2005; 32 2005; 65 2008; 24 1999; 53 2002 2008; 71 2008; 197 1993; 167 e_1_2_6_20_2 Wilson D (e_1_2_6_7_2) 2002 e_1_2_6_8_2 e_1_2_6_18_2 e_1_2_6_9_2 e_1_2_6_19_2 e_1_2_6_4_2 e_1_2_6_3_2 e_1_2_6_6_2 e_1_2_6_5_2 e_1_2_6_12_2 e_1_2_6_13_2 e_1_2_6_2_2 e_1_2_6_10_2 e_1_2_6_22_2 e_1_2_6_11_2 e_1_2_6_21_2 e_1_2_6_16_2 e_1_2_6_17_2 e_1_2_6_14_2 e_1_2_6_15_2 |
| References_xml | – reference: Cherry CL, Wesselingh SL, Lal L, McArthur JC. Evaluation of a clinical screening tool for HIV-associated sensory neuropathies. Neurology 2005; 65: 1778-1781. – reference: Affandi JS, Price P, Imran D, Yunihastuti E, Djauzi S, Cherry CL. Can we predict neuropathy risk before stavudine prescription in a resource-limited setting?. AIDS Res Hum Retroviruses 2008; 24: 1281-1284. – reference: 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: 816-824. – reference: Wright E, Brew B, Araywichanont A, Robertson K, Samintharapanya K, Kongsaengdao S, et al. Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region. Neurology 2008; 71: 50-56. – reference: Cherry CL, Skolasky RL, Lal L, Creighton J, Hauer P, Raman SP, et al. Antiretroviral use and other risks for HIV-associated neuropathies in an international cohort. Neurology 2006; 66: 867-873. – reference: Sithinamsuwan P, Punthanamongkol S, Valcour V, Onsanit S, Nidhinandana S, Thitivichianlert S, et al. Frequency and characteristics of HIV-associated sensory neuropathy among HIV patients in Bangkok, Thailand. J Acquir Immune Defic Syndr 2008; 49: 456-458. – reference: Browne MJ, Mayer KH, Chafee SB, Dudley MN, Posner MR, Steinberg SM, et al. 2',3'-Didehydro-3'-deoxythymidine (d4T) in patients with AIDS or AIDS-related complex: a phase I trial. J Infect Dis 1993; 167: 21-29. – reference: Cornblath DR, Chaudry V, Carter K, Lee D, Seysedadr M, Miernicki M, et al. Total neuropathy score: validation and reliability study. Neurology 1999; 53: 1660-1664. – reference: American Diabetic Association position statement: standards of medical care in diabetes-2009. Diabetes Care 2009; 32( Suppl 1): S13-61. – reference: Hung CF, Gibson SA, Letendre SL, Lonergan JT, Marquie-Beck JA, Vaida F, et al. Impact of long-term treatment with neurotoxic dideoxynucleosides antiretrovirals: implications for clinical care in resource-limited settings. HIV Med 2008; 9: 731-737. – reference: Villamor E, Mugusi F, Urassa W, Bosch RJ, Saathoff E, Matsumoto K, et al. A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis. J Infect Dis 2008; 197: 1499-1505. – reference: Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of Adult AIDS Clinical Trials Group (AACTG). AIDS Care 2000; 12: 255-266. – reference: Morgello S, Estanislao L, Simpson D, Geraci A, Di Rocco 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; 546-551. – reference: Smyth K, Affandi JS, McArthur JC, Bowtell-Harris C, Mijch AM, Watson K, et al. Prevalence of and risk factors for HIV-associated neuropathy in Melbourne, Australia 1993-2006. HIV Med 2007; 8: 367-373. – reference: Schifitto G, McDermott MP, McArthur JC, Marder K, Sacktor N, Epstein L, et al. Incidence of and risk factors for HIV-associated distal sensory polyneuropathy. Neurology 2002; 58: 1764-1768. – reference: Pandya R, Krentz HB, Gill MJ, Power C. HIV-related neurological syndromes reduce health-related quality of life. Can J Neurol Sci 2005; 32: 201-204. – reference: Lawn SD, Myer L, Bekker L-G, Wood R. Burden of tuberculosis in an antiretroviral treatment programme in sub-Saharan Africa: impact on treatment outcomes and implications for tuberculosis control. AIDS 2006; 20: 1605-1612. – volume: 32 start-page: 201 year: 2005 end-page: 204 article-title: HIV‐related neurological syndromes reduce health‐related quality of life publication-title: Can J Neurol Sci – volume: 53 start-page: 1660 year: 1999 end-page: 1664 article-title: Total neuropathy score: validation and reliability study publication-title: Neurology – year: 2009 – volume: 58 start-page: 1764 year: 2002 end-page: 1768 article-title: Incidence of and risk factors for HIV‐associated distal sensory polyneuropathy publication-title: Neurology – volume: 9 start-page: 731 year: 2008 end-page: 737 article-title: Impact of long‐term treatment with neurotoxic dideoxynucleosides antiretrovirals: implications for clinical care in resource‐limited settings publication-title: HIV Med – volume: 197 start-page: 1499 year: 2008 end-page: 1505 article-title: A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis publication-title: J Infect Dis – volume: 20 start-page: 1605 year: 2006 end-page: 1612 article-title: Burden of tuberculosis in an antiretroviral treatment programme in sub‐Saharan Africa: impact on treatment outcomes and implications for tuberculosis control publication-title: AIDS – volume: 59 start-page: 816 year: 2006 end-page: 824 article-title: Sensory neuropathy in human immunodeficiency virus/acquired immunodeficiency syndrome patients: protease inhibitor‐mediated neurotoxicity publication-title: Ann Neurol – volume: 24 start-page: 1281 year: 2008 end-page: 1284 article-title: Can we predict neuropathy risk before stavudine prescription in a resource‐limited setting? publication-title: AIDS Res Hum Retroviruses – volume: 32 start-page: S13 issue: Suppl 1 year: 2009 end-page: 61 article-title: American Diabetic Association position statement: standards of medical care in diabetes—2009 publication-title: Diabetes Care – volume: 8 start-page: 367 year: 2007 end-page: 373 article-title: Prevalence of and risk factors for HIV‐associated neuropathy in Melbourne, Australia 1993–2006 publication-title: HIV Med – volume: 49 start-page: 456 year: 2008 end-page: 458 article-title: Frequency and characteristics of HIV‐associated sensory neuropathy among HIV patients in Bangkok, Thailand publication-title: J Acquir Immune Defic Syndr – year: 2001 – year: 2006 – volume: 66 start-page: 867 year: 2006 end-page: 873 article-title: Antiretroviral use and other risks for HIV‐associated neuropathies in an international cohort publication-title: Neurology – start-page: 329 year: 2002 end-page: 340 – volume: 167 start-page: 21 year: 1993 end-page: 29 article-title: 2',3'‐Didehydro‐3'‐deoxythymidine (d4T) in patients with AIDS or AIDS‐related complex: a phase I trial publication-title: J Infect Dis – volume: 71 start-page: 50 year: 2008 end-page: 56 article-title: Neurologic disorders are prevalent in HIV‐positive outpatients in the Asia‐Pacific region publication-title: Neurology – volume: 65 start-page: 1778 year: 2005 end-page: 1781 article-title: Evaluation of a clinical screening tool for HIV‐associated sensory neuropathies publication-title: Neurology – volume: 12 start-page: 255 year: 2000 end-page: 266 article-title: Self‐reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of Adult AIDS Clinical Trials Group (AACTG) publication-title: AIDS Care – volume: 61 start-page: 546 year: 2004 end-page: 551 article-title: HIV‐associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy: the Manhattan HIV Brain Bank publication-title: Arch Neurol – ident: e_1_2_6_11_2 doi: 10.1212/01.wnl.0000187119.33075.41 – ident: e_1_2_6_9_2 doi: 10.1111/j.1468-1293.2007.00478.x – ident: e_1_2_6_15_2 doi: 10.1212/01.wnl.0000316390.17248.65 – ident: e_1_2_6_2_2 – ident: e_1_2_6_10_2 – ident: e_1_2_6_13_2 doi: 10.1080/09540120050042891 – ident: e_1_2_6_6_2 doi: 10.1002/ana.20816 – ident: e_1_2_6_17_2 doi: 10.1212/01.wnl.0000203336.12114.09 – ident: e_1_2_6_3_2 doi: 10.1212/WNL.58.12.1764 – ident: e_1_2_6_21_2 – ident: e_1_2_6_5_2 doi: 10.1017/S0317167100003978 – ident: e_1_2_6_14_2 doi: 10.2337/dc09-S013 – ident: e_1_2_6_12_2 doi: 10.1212/WNL.53.8.1660 – ident: e_1_2_6_20_2 doi: 10.1086/587846 – ident: e_1_2_6_18_2 doi: 10.1089/aid.2008.0045 – ident: e_1_2_6_16_2 doi: 10.1111/j.1468-1293.2008.00615.x – ident: e_1_2_6_19_2 doi: 10.1097/01.aids.0000238406.93249.cd – ident: e_1_2_6_22_2 doi: 10.1097/QAI.0b013e318186eb03 – start-page: 329 volume-title: Handbook of HIV medicine year: 2002 ident: e_1_2_6_7_2 – ident: e_1_2_6_4_2 doi: 10.1001/archneur.61.4.546 – ident: e_1_2_6_8_2 doi: 10.1093/infdis/167.1.21 |
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| SubjectTerms | Adult Africa Age Distribution Age Factors AIDS Alcoholism - epidemiology Anti-HIV Agents - adverse effects antiretroviral toxic neuropathy Biological and medical sciences Causality CD4 Lymphocyte Count Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction Cross-Sectional Studies Diseases of striated muscles. Neuromuscular diseases distal sensory polyneuropathy Female HIV HIV Infections - epidemiology Human immunodeficiency virus Humans Male Medical sciences Mycobacterium Nervous system (semeiology, syndromes) Neurology nucleoside reverse transcriptase inhibitors Paresthesia - epidemiology Peripheral Nervous System Diseases - epidemiology Prospective Studies Retrospective Studies Risk Assessment - methods Risk Factors South Africa - epidemiology Stavudine - adverse effects Surveys and Questionnaires tuberculosis Tuberculosis - epidemiology |
| Title | HIV neuropathy in South Africans: Frequency, characteristics, and risk factors |
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