Modification of the incidence of drug-associated symmetrical peripheral neuropathy by host and disease factors in the HIV outpatient study cohort
Modification of the incidence of drug-associated symmetrical peripheral neuropathy by host and disease factors in the HIV outpatient study cohort
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DOI：
10.1086/426076
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发表时间：
2005-01-01
影响因子：
11.8
通讯作者：
Holmberg, SD
中科院分区：
文献类型：
--
作者：
Lichtenstein, KA;Armon, C;Holmberg, SD
背景我们试图通过一项回顾性纵向队列分析，确定在高效抗逆转录病毒治疗（HAART）时期与对称性周围神经病变（SPN）临床诊断相关的因素。通过单因素和多因素Logistic回归分析，评估人类免疫缺陷病毒1型感染患者SPN的临床体征及其与免疫学、病毒学、临床和药物治疗因素的相关性。在2515例患者中，329例（13.1%）被诊断为SPN。在逻辑回归分析中，SPN的统计学显著性非药物性风险因素为年龄> 140岁（校正比值比[ aOR]，1.17）、糖尿病（aOR，1.79）、白色人种（aOR，1.33）、首次测量时CD 4（+）T淋巴细胞计数最低值> 110，000拷贝/ mL（aOR，1.44）。虽然最初使用去羟肌苷，司他夫定（40 mg B. I. d.），奈韦拉平或4种蛋白酶抑制剂与SPN相关（所有4种治疗的OR均>1.41），随着所有研究药物的继续使用，相关性强度降低。自从HAART引入以来，SPN的发生率有所下降。宿主因素和疾病严重程度增加的体征与暴露于药物治疗的初始阶段发生SPN的风险增加相关。持续使用HAART可提高免疫力，降低SPN风险。延迟治疗的开始可能会选择那些更有可能发展为SPN的个体，并且早期开始HAART可能会降低发展这种常见问题的风险，以及增加治疗效果并降低药物的毒性作用。
Background. We sought to identify factors associated with the clinical diagnosis of symmetrical peripheral neuropathy ( SPN) during the era of highly active antiretroviral therapy ( HAART) in a retrospective, longitudinal cohort analysis.Methods. Patients infected with human immunodeficiency virus type 1 were evaluated for clinical signs of SPN and its association with immunologic, virologic, clinical, and drug treatment factors by means of univariate and multivariate logistic regression analyses.Results. Of 2515 patients, 329 ( 13.1%) received a diagnosis of SPN. In the logistic regression analysis, statistically significant non - drug- based risk factors for SPN were age 140 years ( adjusted odds ratio [ aOR], 1.17), diabetes mellitus ( aOR, 1.79), white race ( aOR, 1.33), nadir CD4(+) T lymphocyte count 110,000 copies/ mL at first measurement ( aOR, 1.44). Although initial use of didanosine, stavudine ( 40 mg b. i. d.), nevirapine, or 4 protease inhibitors was associated with SPN ( ORs for all 4 treatments, >1.41), the strength of association decreased with continued use of all medications studied.Conclusion. Since HAART was introduced, the incidence of SPN has decreased. Host factors and signs of increased disease severity were associated with an increased risk of developing SPN during the initial period of exposure to drug therapy. Immunity improved and the risk of SPN decreased with continued use of HAART. Delaying the initiation of therapy may select those individuals who will be more likely to develop SPN, and earlier initiation of HAART may decrease the risk of developing this common problem, as well as increase the therapeutic effects and decrease the toxic effects of the drugs.