HIV infection can cause many problems, including some that affect the nerves. The central nervous system that permeates the bulk of the body outside of the brain is called the peripheral nervous system. Early in 1983, doctors in Manhattan observed odd-looking lesions on nerves in the feet and legs of people with HIV. This type of injury is called Peripheral neuropathy. Neurologists found that peripheral neuropathy usually first appears in the toes and feet and may result in numbness, pain and intermittent sensations. In one study, doctors have documented the serious nature of pain associated with peripheral neuropathy and found that patients suffering used strong words such as the following to describe what they feel, "punches", "burning", "within the chilled water" "I do not feel his hands or fingers and" extremely painful ".
Possible causes of peripheral neuropathy
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)
- DDI (didanosine, Videx)
- The DDC (zalcitabine, Hivid)
Although the use of ddC quickly fell out of use because of its high toxicity and weak antiviral effect, ddI and d4T continued to be used in the early 21 century as part of the most potent combinations of anti-HIV therapy (commonly called ART or HAART). These "drugs d" can be toxic to nerve cells, and even in the early 1990, doctors discovered that they could also cause peripheral neuropathy.
However, nowadays, the use of "drugs d" is strongly discouraged by the guidelines and treatment protocols in high-income countries, so its use is shown to be unlikely as a cause of new cases of peripheral neuropathy. However, peripheral neuropathy arising continues ...
Peripheral neuropathy today
Researchers from large clinical centers in the US came together to study potential causes of peripheral neuropathy among HIV positive people in the modern era. They recruited about 500 people who were free of peripheral neuropathy and were monitored for an average of two years, conducting extensive evaluations. Taking into account a number of issues, statistical analysis it was found that there were several factors associated with increased risk of peripheral neuropathy. TheCATIE, newsletter (Translator's note: origin of this text in English), Is to explore some of these findings and what they indicate.
Study Details peripheral neuropathy related to HIV disease
The researchers recruited 1.583 people with HIV (Seropositive) between the years 2003 and 2010 of a large study of HIV and neurological problems. A subset of this group - n. º 493 people - who had no peripheral neuropathy when they entered the study composed the group of participants for the ongoing examination.
The doctors and nurses were trained by neurologists to interview, analyze and evaluate the participants for any signs and symptoms of peripheral neuropathy. Participants were also screened for the disease. Blood samples and additional information was obtained from medical records were collected.
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
- Doctors diagnose 73% of participants with some form of "use disorder or abuse legal or illegal psychotropic substance;" substances commonly used were alcohol (55%), cocaine (40%), crystal meth (18%) and opioids (heroin, for example) (17%).
Results of the study on peripheral neuropathy
After an average follow-up of two years, 131 participants (27%), which were free of peripheral neuropathy at baseline developed later Peripheral Neuropathy.
Possible risk factors for Peripheral 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 relationship with peripheral neuropathy
The researchers concluded that "HIV disease" and treatment have affected significantly the overall condition of the peripheral nervous system [with significant rates of new cases of peripheral neuropathy] in this study. For example, they found that "most peripheral neuropathy rate occurred in a relatively small group of people (50 people) that had [previously used HAART, but had discontinued these treatments]." The reasons for switching were not disclosed. These subjects had, in many cases, low CD4 cell count because they were not treated.
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:
"Because of the likelihood of the 30 40%% of HIV-infected people on ART in the United States does not maintain durable virologic suppression because of transfer of the health service, poor compliance and other factors, our findings suggest that [peripheral neuropathy] will be a persistent problem or growing. "
The researchers found 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 suffered minimum 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 use / abuse opioids were more likely to subsequently develop peripheral neuropathy.
The disease - Participants that HIV infection has become more severe over study (time) were more likely to develop peripheral neuropathy.
Sex - Women are more likely to develop peripheral neuropathy than men. This diagnosis should be explored in further analysis, but may be related to biological and genetic factors, hormonal or social and psychological factors, such as substance abuse and eventually depression.
Pain, depression and peripheral neuropathy
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 found that "regardless of the underlying cause / underlying pain and depression are mutually reinforcing." They also noted that depression changes the brain, and the 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, alter or misrepresent "brain paths" make people more vulnerable to pain experiment, particularly when the brain receives and tries to process the signals from the nerves that are dysfunctional because 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.
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:
(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; however, a remotely distant past, I took DDI, the ironically named "Videx", which was to approximate size of a tablet of "Fruit Salt ENO" not efervescia when placed in water and all I could do with it was chews it up to swallow him power, and I missed the times that I threw up with it, or dissolve it in water or orange juice; the big problem is that in order to generate an acceptable serum levels of "medicine" for good bioavailability was necessary to maintain a prior and subsequent one-hour fast without eating anything, not water, and only the devil could have invented a form of torture greater than this! Furthermore, I suffer, for fifteen years, with depression, may still be a longer time and this may have been, yes, and I am very sorry to admit it, one way for the deployment of peripheral neuropathy in me (...)!
This translation may be reprinted with the express permission oftranslator.
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
- Snider WD, Simpson DM, Nielsen S, et al. Neurological complications of acquired immune deficiency syndrome: analysis of 50 pacientes.Annals of Neurology. 1983 Oct;14(4):403-18.
- Malvar J, Vaida F, CF Sanders, et al. Predictors of new-onset distal neuropathic pain in HIV-infected Individuals in the era of combination antiretroviral therapy.Pain. 2015 Apr;156(4):731-9.
- Keltner JR, Fennema-Notestine C, Vaida F, et al. HIV-associated distal neuropathic pain is associated with smaller overall cerebral cortical gray matter.Journal of Neurovirology. 2014 Jun;20(3):209-18.
- Keltner JR, Vaida F, Ellis RJ, et al. Health-related quality of life "well-being" in HIV distal neuropathic pain is more strongly associated with depression severity than with pain intensity. 2012 Jul-Aug; 53 (4): 380-6.
- Ellis RJ, Rosario D, Clifford DB, et al. Continued high prevalence and adverse clinical impact of human immunodeficiency virus-associated sensory neuropathy in the era of combination antiretroviral therapy: the CHARTER Study.Archives of Neurology.2010 May;67(5):552-8.
- Kallianpur AR, Jia P, Ellis RJ, et al. Genetic variation in iron metabolism is associated with neuropathic pain and pain severity in HIV-infected Patients on antiretroviral therapy.PLoS One. 2014 21 Aug; 9 (8): e103123.
- Badiee J, Moore DJ, Atkinson JH, et al. Lifetime suicidal ideation and attempt are common Among HIV-positive Individuals.Journal of Affective Disorders. 2012 Feb;136(3):993-9.
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