Determinants of sensory neuropathy among HIV/AIDS patients attending comprehensive care clinic at Webuye County Hospital, Kenya

Abstract

Background: Sensory neuropathy is a frequent complication of HIV infection. It is widely under-recognised and undertreated in resource constrained settings. It is estimated that the prevalence of HIV associated sensory neuropathy (HIV-SN) globally ranges from 30% to 60% or more in antiretroviral therapy (ART) treated cohorts. Up to 90 % of affected patients experience potentially debilitating neuropathic pain and reduced quality of life. Objective: To assess the prevalence and determinants associated with HIV-SN in patients attending Webuye County Hospital comprehensive care clinic (CCC). Methods: A total of 340 HIV positive adult patients were randomly selected for this cross sectional study. A pre-tested structured questionnaire was used to collect data. Patients with HIV-SN were identified using the Brief Peripheral Neuropathy Screening (BPNS) tool. HIV-SN was defined as the presence of neuropathic symptoms and at least an abnormal perception of vibration or abnormal ankle reflexes or both. Demographic, clinical, and laboratory factors determined from literature review were considered as possible determinants for HIV-SN. Analysis was done using R software for statistical analysis. Association between categorical variables and HIV-SN was assessed using Pearson’s Chi Square test. Association between HIV-SN and normally distributed continuous variables was assessed using two sample t-test. Results: The mean age was 42.5 ± 11.0 years. The male to female ratio was 1:2. The median current viral load was 0.0 copies/ml, the median baseline CD4 Count was 203 cells/mm3 and the median duration of HIV from diagnosis was 6 years. The prevalence of HIV-SN was 30.0% (95% CI: 25.2% to 35.2%). Age, OR: 1.04 (95% CI: 1.01, 1.06) was associated with HIV-SN, that is older participants were more likely to be diagnosed with HIV-SN. Participants who had higher baseline CD4 count (CD4>350 cells/mm3) had 49% reduced odds of HIV-SN, OR: 0.51 (95% CI: 0.28, 0.99) while those with hypertension had more than threefold likelihood of having HIV-SN OR: 3.26 (95% CI: 1.40, 7.57). Conclusions: There is high prevalence of HIV-SN. Age and baseline CD4 count were associated with HIV-SN. Hypertension, a less studied factor (comorbidity) was strongly associated with HIV-SN. Recommendations: Since increasing age was associated with HIV-SN, we recommend routine screening of adult patients for HIV-SN during clinic visits. Further study to evaluate the role of hypertension in HIV-SN.