HIV-associated painful neuropathy: where are we?

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.

Keywords:
Morbidity; HIV; Quality of Life

Sociodemographic variables		HIV-positive patients				P-value of Fisher's exact test
		WITH painful neuropathy (n = 24)		NO painful neuropathy (n = 40)
		n	%	n	%
Sex	Female	13	54.2	22	55.0	1.000
Sex	Male	11	45.8	18	45.0	1.000
Age	31 - 39 years	5	20.8	14	35.0	0.396
	40 - 49 years	12	50.0	14	35.0
	50 - 55 years	7	29.2	12	30.0
Educational level	Up to 5 years of schooling	10	41.7	9	22.5	0.001
	6 - 9 years of schooling	7	29.2	29	72.5
	10 or more years of schooling	7	29.2	2	5.0
Income (minimum monthly wages)	1 - 2 mw	3	12.5	1	2.5	0.353
	2 - 3 mw	9	37.5	14	35.0
	3 - 4 mw	11	45.8	20	50.0
	> 4 mw	1	4.2	5	12.5

Variables not related to HIV		HIV+ patients				P-value of Fisher's exact test
		WITH painful neuropathy (n = 24)		NO painful neuropathy (n=40)
		n	%	n	%
Physical activity	Yes	5	20.8	16	40.0	0.170
Physical activity	No	19	79.2	24	60.0	0.170
BMI (kg/m²)	Up to 24.9 (normal)	7	29.2	25	62.5	0.003
	25 - 29.9 (overweight)	14	58.3	7	17.5
	30 or more (obesity)	3	12.5	8	20.0
History of depression	Yes	13	54.2	19	47.5	0.797
History of depression	No	11	45.8	21	52.5	0.797

Variables related to HIV		HIV-positive patients				P-value of Fisher's exact test
		WITH painful neuropathy (n = 24)		NO painful neuropathy (n=40)
		n	%	n	%
Length of time with the diagnosis of HIV infection	Up to 4 years	5	20.8	3	7.5	0.006
	5 - 9 years	5	20.8	21	52.5
	10 - 14 years	7	29.2	14	35.0
	15 or more	7	29.2	2	5.0
Number of ARV used	Up to 5	18	75.0	34	85.0	0.341
Number of ARV used	6 or more	6	25.0	6	15.0	0.341
Length of HAART use	Up to 9 years	11	45.8	26	65.0	0.192
Length of HAART use	10 or more	13	54.2	14	35.0	0.192
Number of hospitalizations	0	9	37.5	23	57.5	0.071
	1	6	25.0	12	30.0
	2 or more	9	37.5	5	12.5
Number of clinical manifestations related to HIV	0	3	12.5	14	35.0	0.130
	1	9	37.5	13	32.5
	2 or more	12	50.0	13	32.5
History of abandonment of HAART use	Yes	8	33.3	14	35.0	1.000
History of abandonment of HAART use	No	16	66.7	26	65.0	1.000
CD4 cell count	Up to 499	6	25.0	13	32.5	0.583
CD4 cell count	500 or more	18	75.0	27	67.5	0.583
Viral load	Undetectable	20	83.3	35	87.5	0.718
Viral load	Detectable	4	16.7	5	12.5	0.718
Time of VL detectable since diagnosis	1 year	8	33.3	26	65.0	0.051
	2 years	7	29.2	6	15.0
	3 years or more	9	37.5	8	20.0

Variables	HIV-positive groups	Descriptive statistics					Mann-Whitney test p-value
	HIV-positive groups	Average	Standard deviation	Minimum	Median	Maximum
	Age (years)	With painful neuropathy	46.7	5.8	35.0	47.5		55.0	0.296
No painful neuropathy	Age (years)	44.2	7.4	31.0	43.5	55.0			0.296
Years of study	With painful neuropathy	6.7	3.0	4.0	6.0	13.0	0.583
Years of study	No painful neuropathy	6.6	1.7	4.0	6.0	12.0	0.583
Income (MW)	With painful neuropathy	2.4	0.8	1.0	2.5	4.0	0.155
Income (MW)	No painful neuropathy	2.7	0.7	1.0	3.0	4.0	0.155
BMI (kg/m²)	With painful neuropathy	26.2	5.4	18.3	26.0	42.3	0.291
BMI (kg/m²)	No painful neuropathy	25.7	6.1	18.0	24.7	40.0	0.291
Infection duration (years)	With painful neuropathy	10.7	5.5	2.0	11.5	21.0	0.117
Infection duration (years)	No painful neuropathy	8.7	4.0	4.0	8.0	21.0	0.117
Number of ARV used	With painful neuropathy	4.5	1.5	3.0	4.0	9.0	0.522
Number of ARV used	No painful neuropathy	4.2	1.2	3.0	4.0	7.0	0.522
Duration of use of HAART (years)	With painful neuropathy	9.3	4.8	2.0	10.5	19.0	0.185
Duration of use of HAART (years)	No painful neuropathy	7.8	3.1	4.0	7.0	14.0	0.185
Number of clinical manifestations	With painful neuropathy	1.8	1.3	0.0	1.5	4.0	0.026
Number of clinical manifestations	No painful neuropathy	1.1	1.1	0.0	1.0	5.0	0.026
CD4	With painful neuropathy	670	345	14	682	1.257	0.321
CD4	No painful neuropathy	760	313	221	814	1.327	0.321
Detectable VL duration (years)	With painful neuropathy	2.9	2.7	1.0	2.0	12.0	0.019
Detectable VL duration (years)	No painful neuropathy	1.9	1.6	1.0	1.0	8.0	0.019

SF-36 domains	HIV-positive groups	Descriptive statistics					d = effect size	Mann-Whitney test p-value
SF-36 domains	HIV-positive groups	Average	Standard deviation	Minimum	Median	Maximum	d = effect size	Mann-Whitney test p-value
Functional capacity	With painful neuropathy	46.9	24.1	10.0	45.0	100.0	-2.9	0.008
Functional capacity	No painful neuropathy	95.4	9.7	60.0	100.0	100.0	-2.9	0.008
Physical aspects	With painful neuropathy	36.5	29.5	0.0	25.0	100.0	-2.1	< 0.001
Physical aspects	No painful neuropathy	91.3	24.4	0.0	100.0	100.0	-2.1	< 0.001
Pain	With painful neuropathy	40.2	12.4	20.0	41.0	52.0	-4.2	< 0.001
Pain	No painful neuropathy	93.5	12.9	51.0	100.0	100.0	-4.2	< 0.001
Emotional aspects	With painful neuropathy	24.9	32.4	0.0	25.0	100.0	-2.5	< 0.001
Emotional aspects	No painful neuropathy	90.5	22.0	0.0	100.0	100.0	-2.5	< 0.001
General health status	With painful neuropathy	52.5	23.8	27.0	42.0	92.0	-1.9	< 0.001
General health status	No painful neuropathy	87.3	14.2	40.0	89.5	100.0	-1.9	< 0.001
Vitality	With painful neuropathy	39.5	21.8	15.0	32.5	90.0	-1.5	< 0.001
Vitality	No painful neuropathy	75.9	26.6	0.0	87.5	100.0	-1.5	< 0.001
Social aspects	With painful neuropathy	39.0	26.5	12.0	25.0	100.0	-3.5	< 0.001
Social aspects	No painful neuropathy	98.1	6.7	75.0	100.0	100.0	-3.5	< 0.001
Mental health	With painful neuropathy	51.0	20.3	24.0	42.0	92.0	-1.8	< 0.001
Mental health	No painful neuropathy	84.3	16.9	32.0	91.0	100.0	-1.8	< 0.001

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[1] Correspondence:
Osvaldo José Moreira do Nascimento; Email: osvaldo_nascimento@hotmail.com.