Peripheral neuropathy and HIV or peripheral neuropathy by HIV can generate a difficult picture
HIV infection can cause many problems, including some that affect the nerves. The central nervous system that permeates most of the body outside the brain is called the peripheral nervous system. Early in 1983, doctors in Manhattan observed odd-looking lesions on the nerves of the feet and legs of people with HIV. This type of injury is called peripheral neuropathy. Neurologists have discovered that peripheral neuropathy usually first appears on the toes and feet and can result in numbness, pain and intermittent sensations. In one study, physicians have documented the serious nature of the pain associated with peripheral neuropathy and found that affected patients used strong words such as the following to describe what they feel: "strokes", "burning", "inside the icy water" , "I do not feel the hands or the fingers and" extremely painful ".
Possible causes of peripheral neuropathy due to HIV
The causes of peripheral neuropathy among HIV positive people may vary. For example, in the early 1980 when no effective treatment was available, peripheral neuropathy was probably a consequence of HIV disease untreated. In the decade of 1990, a group of anti-HIV drugs commonly called "" drugs d "" was often used:
- D4T (stavudine, Zerit)
- IDD (didanosine, Videx)
- DDC (zalcitabine, Hivid)
Although the use of ddC rapidly fell out of use because of its high toxicity and weak antiviral effect, ddI and d4T continued to be used early in the 21 century as part of more potent anti-HIV therapy combinations called HAART or HAART). These "d-drugs" may be toxic to nerve cells, and even in the early 1990 decade, doctors have discovered that they could also cause peripheral neuropathy.
However, nowadays, the use of "d-drugs" is strongly discouraged by treatment guidelines and protocols in high-income countries, so their use is unlikely to be the cause of new cases of peripheral neuropathy. However, peripheral neuropathy continues to arise ...
Peripheral HIV Neuropathy Today
Researchers from major clinical centers in the United States have teamed up to study potential causes of peripheral neuropathy among HIV positive people in modern times. They recruited about 500 people who were free of peripheral neuropathy and who were monitored for an average of two years, performing extensive evaluations. Taking into account several issues, the statistical analysis found that there were several factors associated with the increased risk of peripheral neuropathy. O CATIE, newsletter (Translator's note: origin of this text in English ), proposes to explore some of these findings and what they indicate.
Details of the study of peripheral HIV neuropathy
The researchers recruited 1.583 people with HIV (seropositive) between the years 2003 and 2010 of a large study on the HIV virus and neurological problems.
A subset of this group - n. 493 people - who had no peripheral neuropathy when they entered the study composed the group of participants for the ongoing analysis.
Physicians and nurses were trained by neurologists to interview, analyze and evaluate participants for any signs and symptoms of peripheral neuropathy.
Participants were also screened for the disease. Blood samples were collected and additional information was obtained from medical records.
The average profile of 493 participants when they entered the study was as follows:
- 81% Of men, 19% of women
- Average age - 42 years
- 68% (335 people) were taking HAART, which 201 (61%) had an undetectable viral load
- Approximately one third of the participants had previously been exposed to or DDI d4T
- 14% of the participants were taking d4T or DDI when they entered the study
- (73%), cocaine (55%), crystal meth (40%), and opioids (18%) were the most commonly used drugs. (heroin, for example) (17%).
Results of the study on peripheral neuropathy and hiv
After an average of two years of follow-up, 131 participants (27%), of whom were free from peripheral neuropathy at the start of the study, subsequently developed Peripheral Neuropathy.
Possible Risk Factors for Peripheral HIV Neuropathy
Taking several factors into account, the researchers found statistical links between a number of factors, and the subsequent development of peripheral neuropathy. Here are some of these factors:
- Age (50 years or more) - This finding is important because as HIV positive people has advanced in median survival, with the natural elevating the average age of people living with HIV or AIDS, Can be diagnosed with peripheral neuropathy.
- HIV viral load detected - untreated or poorly managed treatment for HIV infection results in a higher degree of inflammation of peripheral nerves of the body. The HIV-infected cells also produce viral proteins that injure the nerve cells. Thus it is not surprising that researchers discovered that participants with detectable HIV viral load were more likely to develop peripheral neuropathy than people whose viral loads remained undetectable.
Treatment and its relation to peripheral neuropathy and HIV
The researchers concluded that "HIV disease" and treatment significantly affected the overall state of the peripheral nervous system [presenting significant rates of new cases of peripheral neuropathy] in the present study.
For example, they found that the "highest rate of peripheral neuropathy occurred in a relatively small group of people (50 people) who had [previously used ART but had discontinued these treatments]."
Reasons for interruption were not disclosed. These participants had, in many cases, low CD4 cell count because they were not on treatment.
In part, the new cases of peripheral neuropathy in the group of people could have been due to HIV treatment. Thus, the research team issued the following warning:
"Due to the probability that 30% to 40% of HIV-infected persons on ART in the United States does not maintain durable virologic suppression.
Peripheral Neuropathy is a greater threat if treatment for HIV is not well adhered to
Because of health service transfer, poor adherence and other factors, our findings suggest that peripheral neuropathy IS a persistent and growing problem. "
The researchers observed that participants who had never had ART and who had relatively high CD4 counts were less likely to develop peripheral neuropathy. This is probably due to the fact that their immune systems have undergone minimal levels of degradation.
The researchers also found that the following factors could put participants at a higher risk of developing peripheral neuropathy:
Use of psychotropic substances - People with a history of opioid use / abuse were more likely to subsequently develop peripheral neuropathy.
The disease - Participants in whom HIV infection became more severe throughout the study (time of) were more likely to develop peripheral neuropathy.
Gender - Women are more likely to develop peripheral neuropathy than men. This diagnosis should be explored in another analysis, but may be related to biological and genetic factors, hormonal or social and psychological factors, such as psychoactive substance use and eventually depression.
Pain, depression and peripheral neuropathy
Suicidal thoughts are common to me because of neuropathic pain (I Claudius so declare)
The researchers noted that people affected by "intersection opioid / depression" suffered a worsening in the development of peripheral neuropathy. They suspect that the pathways used by brain cells to communicate with each other are affected by addiction (see note at the end of the article) and the "overlap of neurological pathways" that deal with the pain.
They noted that previous research had already found that "regardless of the underlying cause / underlying pain and depression reinforce each other." They also pointed out that depression alters the brain, and stimuli that are not normally painful can be experienced as pain in depressed people. It is possible that in people with a history of addiction or use of psychotropic substances, altering or misrepresenting "brain pathways" makes people more vulnerable to the pain experiment, particularly when the brain receives and attempts to process the signs of nerves that are dysfunctional on account of peripheral neuropathy.
The modern era and peripheral neuropathy
The findings of the present age are important, and underlined peripheral neuropathy related to risk factors are different from those of other times.
For example, in the past, the high glycemic index and the mere presence of diabetes type 2 between HIV positive people acted as cofactors in the development of peripheral neuropathy. However, in the present study did not find any relation to these factors. Part of the reason for this is that only a small proportion of subjects suffered from diabetes type 2 (8%).
Additionally, at other times, the use of "drugs d" was a major factor in the development of peripheral neuropathy. Today, however, "Drug d" are rarely used, and even in cases where they were removed by the treatment in the present study, therefore, its use was not related to the development of peripheral neuropathy.
In general, drug and alcohol are important cofactors for the development of peripheral neuropathy. This occurs in part because alcohol may be toxic to nerves and because it depletes the body nutrients (such as vitamins B) which are required for nerve cells. However, the researchers found no alcohol use associated with peripheral neuropathy in this study.
Future research on analgesia and pain linked to peripheral HIV neuropathy
Peripheral neuropathy can cause pain, disability, and reduced quality of life. The researchers said "neuropathic pain can be [overwhelming] in severity"; Also, sometimes, peripheral neuropathy may disappear or go into remission "spontaneously or as treatment outcome and can even occur again at a later time. "This fact underlines the importance of studying the peripheral neuropathy.
The researchers suggest that future studies are needed to address strategies to help prevent the onset of peripheral neuropathy, particularly among people at high risk for this complication, such as people who use opioids or suffering with depression.
Translated from English to Portuguese of Brazil with the support of babylon technology Claudio Souza and reviewed by the Beloved M. *. M. in 02 / 04 / 2015 the original:
My Sad Vision
(Note the Seropositive Editor Web Site: I suffer from very severe peripheral neuropathy and never made use of opioids in my life and to be honest, never consume alcohol outside the festive days of the end of years and my annual alcohol consumption is summarized in two bottles, half pint type of malzebier and in my history, there is effective use of marijuana (which is even recommended to relieve the pain of people with peripheral neuropathy, as well as the alleviation of pain " terminal illness "as the c6ncer) consistently until I was a little more 21 years and have felt the first" kick in the belly "of my first daughter (thank Vivian), which led me to a new state of consciousness where paternity and drug use has become incompatible. However, as I said, I suffer from peripheral neuropathy and you see a kind of dramatic appeal in the text PAIN IN PATIENTS HIV POSITIVE;
Only I know
However, in a distant past, I took IDD, the ironically called "Videx", which was about the size of a "Fruit Salt ENO" tablet that did not fizz when put in the water and all I could do with it was chew it until I could swallow it, and I would lose count of the times I vomited with it, or dissolve it in water or orange juice; the great problem is that to be able to generate an acceptable serum level of this "remedy", for a good bioavailability it was necessary to maintain a previous and later fast of one hour without ingesting anything, nor water, and only the Devil could have invented a form of torture bigger than this! In addition, I suffered from depression fifteen years ago, maybe it is still a longer time and this may have been yes, and I am very sorry to admit it, one of the ways to implant peripheral neuropathy in me ...!
This translation can only be republished with the express authorization of the translator.
Failure to do so may result in protective measures
Nerve pain and numbness - Practical Guide to HIV Drug Side Effects
Ask the Experts: Peripheral Neuropathy - The Positive Side
-Sean R. Hosein
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