Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Peripheral neuropathy in HIV-infected and uninfected patients in Rakai, Uganda

TitlePeripheral neuropathy in HIV-infected and uninfected patients in Rakai, Uganda
Publication TypeJournal Article
Year of Publication2017
AuthorsSaylor, D, Nakigozi, G, Nakasujja, N, Robertson, K, Gray, RH, Wawer, MJ, Sacktor, N
Date PublishedAug 01
ISBN Number0028-3878
Accession Number28679596
KeywordsAdult, Age Factors, Depression/complications/epidemiology, Fatigue/complications/epidemiology, Female, HIV Infections/*complications/*epidemiology, Humans, Karnofsky Performance Status, Male, Peripheral Nervous System Diseases/*complications/*epidemiology/physiopathology, Prevalence, Prospective Studies, Risk Factors, Rural Population, Sex Factors, Tobacco Use/epidemiology, Uganda/epidemiology

OBJECTIVE: To determine the prevalence, risk factors, and functional impairment associated with peripheral neuropathy in a prospective cohort of adults in rural Uganda. METHODS: Eight hundred participants (400 HIV- and 400 antiretroviral-naive HIV+) in the Rakai Community Cohort Study underwent detailed neurologic evaluations including assessment of neuropathy symptoms, functional measures (Patient Assessment of Own Functioning Inventory and Karnofsky Performance Status scores), and neurologic evaluation by a trained medical officer. Neuropathy was defined as >/=1 subjective symptom and >/=1 sign of neuropathy on examination. Neuropathy risk factors were assessed using log binomial regression. RESULTS: Fifty-three percent of participants were men, with a mean (SD) age of 35 (8) years. Neuropathy was present in 13% of the cohort and was more common in HIV+ vs HIV- participants (19% vs 7%, p < 0.001). Older age (relative risk [RR] 1.04, 95% confidence interval [CI] 1.02-1.06), female sex (RR 1.49, 95% CI 1.04-2.15), HIV infection (RR 2.82, 95% CI 1.86-4.28), tobacco use (RR 1.59, 95% CI 1.02-2.48), and prior neurotoxic medication use (RR 2.08, 95% CI 1.07-4.05) were significant predictors of neuropathy in the overall cohort. Only older age was associated with neuropathy risk in the HIV+ (RR 1.03, 95% CI 1.01-1.05) and HIV- (RR 1.06, 95% CI 1.02-1.10) cohorts. Neuropathy was associated with impaired functional status on multiple measures across all participant groups. CONCLUSIONS: Peripheral neuropathy is relatively common and associated with impaired functional status among adults in rural Uganda. Older age, female sex, and HIV infection significantly increase the risk of neuropathy. Neuropathy may be an underrecognized but important condition in rural Uganda and warrants further study.