Virologic suppression enhances epidermal nerve fiber recovery in HIV infection.

Type: Published Abstract
Title: Virologic suppression enhances epidermal nerve fiber recovery in HIV infection.
Authors: Ellis RJ, FitzSimons C, McArthur JC, Polydefkis M, Clifford D, Simpson D, Gelman BB, Morgello S, Collier A, Marra C, McCutchan JA, Grant I
Year: 2011
Publication: 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17-20, Rome, Italy
Volume: Issue: Pages:
Abstract:Objective: To evaluate predictors of change over time in skin small nerve fiber density among HIV+ patients. Background: Improving combination antiretroviral therapies (CART) over the past decade have produced better viral suppression and improvements in health among HIV+ individuals, while reducing toxicities. We sought to determine whether these benefits extend to improvements in peripheral nerve integrity as measured by epidermal nerve fiber density (ENFD; fibers/mm). Methods: HIV-infected individuals in the prospective, multisite CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study volunteered to undergo skin biopsies. ENFD was measured by PGP9.5 immunostaining in a central laboratory. CD4 and HIV viral load (VL) were measured by standard techniques. Use of CART and neurotoxic dideoxynucleoside (d-drug) antiretrovirals was by self-report. Results: Subjects were 86 HIV+ men (83%) and women (17%) with self-reported race/ethnicities black (37%), white (48%) and hispanic/other (15%). Each underwent two skin biopsies (median interval 2.0 years [IQR 1.7, 2.2]). At baseline, the median nadir and current CD4 were 180 and 495 cells/mm3. 67 (78%) took CART, 12 took d-drugs and 52 had undetectable plasma VLs (<50 c/mL). 29 (34%) had abnormally reduced ENFD. The mean (SD) changes (improvements) in ankle and thigh ENFD were +0.25 (7.8) and +2.0 (10.8). In a multivariate linear regression model that overall accounted for 62% of the variance, significant predictors of higher follow-up distal ENFD were higher initial ENFD (p=0.0001), younger age (p=0.0001), non-white ethnicity (p=0.004) and virologic suppression at baseline (p=0.01). Among the factors not associated with ENFD at follow-up were current and nadir CD4, change in VL (median -0.02 [IQR -0.25, 0.08] log10 c/mL) and d-drug use. Summary and Implications: Younger individuals and those with virologic suppression on CART had better ENFD at follow-up, suggesting that virologic suppression helps to improve the likelihood of skin small nerve fiber recovery.