Prevalence, correlates and impact of neuropathic pain in HIV infection: the CHARTER Study.

Type: Published Abstract
Title: Prevalence, correlates and impact of neuropathic pain in HIV infection: the CHARTER Study.
Authors: Ellis R, Rosario D, Clifford D, McArthur JC, Simpson D, Alexander T, Gelman B, Collier A, Marra C, Ances B, Grant I
Year: 2009
Publication: American Academy of Neurology
Volume: Issue: Pages:
Abstract:Objective. With the introduction of CART and an aging HIV population, we assessed changes in prevalence, risk factors and clinical impact of neuropathic pain in HIV. Background. Prior to combination antiretroviral therapy (CART), neuropathic pain due to distal sensory polyneuropathy (DSPN) was the most prevalent neurologic complaint in HIV. Methods. Baseline prevalence and clinical correlates of DSPN and pain were assessed in 1,539 HIV-infected individuals enrolled in the prospective, observational, 6-site CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. DSPN was defined as ≥1 clinical sign in a symmetrical, bilateral pattern. Signs included diminished distal vibratory sensation, reduced sharp sensation and ankle reflexes. We examined associations between pain and risk factors (age, gender, neurotoxic dideoxynucleosides [d-drugs] use, nadir CD4 count, plasma viral load, immune recovery [difference between current and nadir CD4], hepatitis C, and substance use disorders [alcohol, opiates]). Effect of pain on quality of life was assessed using the Medical Outcome Study (MOS)-HIV Health Survey. Results. 57% (881/1,539) had clinical signs of neuropathy. Of these, 219 (25%) reported neuropathic pain ranging from slight (n=116, 13%) to severe (n=70, 7%). Neuropathic pain was associated with reduced quality of life compared to those with slight or no pain, measured by the MOS physical health summary score (median [interquartile range]; 34.0[27.6-41.8] vs. 46.2[37.0-55.5];p<0.01). Significant risk factors for pain more than slight were advancing age (odds ratio [OR]=1.26 [95%CI 1.20-1.31],p=0.02) per ten-year increase, prior exposure to d-drugs (OR=1.93 [1.37-2.72],p<0.01), and immune recovery (OR=1.06 [1.0-1.13],p=0.05) per 100 cell increase. Conclusions. Neuropathic pain remains a common problem in HIV infection, but its clinical correlates have changed since CART. Both advancing age and prior neurotoxic d-drug exposure increase the likelihood of neuropathic pain. The increased frequency of neuropathic pain with greater immune reconstitution is possibly consistent with a pathogenic role of inflammation, producing nerve sensitization and disrupting normal nocioceptive transmission.