Age and height predict neuropathy risk in patients with HIV prescribed stavudine
Age and height predict neuropathy risk in patients with HIV prescribed stavudine
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DOI：
10.1212/wnl.0b013e3181af7a22
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发表时间：
2009-07-28
期刊：
影响因子：
9.9
通讯作者：
Price, P.
中科院分区：
文献类型：
--
作者：
Cherry, C. L.;Affandi, J. S.;Price, P.
目的：感觉神经病变是 HIV 感染者的常见问题，是司他夫定的剂量限制性毒性。在一些司他夫定的使用仍然出于经济需要的国家，需要经济实惠的方法来预测神经病变风险来指导处方。因此，我们的目的是在使用抗逆转录病毒药物之前确定预测神经病变风险的因素。方法：2006 年，共有 294 名在墨尔本、吉隆坡和雅加达诊所就诊的患者参加了横断面神经病变筛查计划。神经病变的定义是艾滋病临床试验组简短周围神经病变筛查中出现的症状和体征。人口统计、实验室和治疗细节被认为是神经病变的可能危险因素。然后对 181 名患者进行了患者人口统计学在预测司他夫定神经病变中的作用的评估，这些患者自称在首次服用该药时没有出现神经病变症状。结果：神经病变的患病率在墨尔本 (n = 100) 为 42%，在吉隆坡 (n = 98) 为 19%，在雅加达 (n = 96) 为 34%。除了治疗暴露之外，年龄（p = 0.002）和身高（p = 0.001）的增加与神经病变独立相关。年龄和身高≥170 厘米或≥40 岁可预测神经病。在 181 名使用司他夫定前无症状的患者中，年轻、矮小的患者在使用司他夫定后发生神经病变的风险为 20%，而年长、高大的患者则为 66%。 结论：司他夫定神经病变的风险随着患者年龄和身高的增加而增加。在艾滋病毒疾病负担限制治疗选择的国家，优先考虑年龄较大和身材较高的患者使用替代药物将是一种降低神经病变发生率的廉价策略。神经病学（R）2009； 73：315-320
Objective: Sensory neuropathy is a common problem in HIV-infected patients and is the dose-limiting toxicity of stavudine. Affordable methods of predicting neuropathy risk are needed to guide prescribing in countries where some use of stavudine remains an economic necessity. We therefore aimed to identify factors predictive of neuropathy risk before antiretroviral use.Methods: A total of 294 patients attending clinics in Melbourne, Kuala Lumpur, and Jakarta were enrolled in a cross-sectional neuropathy screening program in 2006. Neuropathy was defined by the presence of symptoms and signs on the AIDS Clinical Trials Group Brief Peripheral Neuropathy Screen. Demographic, laboratory, and treatment details were considered as possible risk factors for neuropathy. The role of patient demographics in predicting stavudine neuropathy were then assessed in 181 patients who reported that they were free of neuropathy symptoms when first prescribed this drug.Results: The prevalence of neuropathy was 42% in Melbourne (n = 100), 19% in Kuala Lumpur (n = 98), and 34% in Jakarta (n = 96). In addition to treatment exposures, increasing age (p = 0.002) and height (p = 0.001) were independently associated with neuropathy. Age and height cutoffs of >= 170 cm or >= 40 years predicted neuropathy. Among 181 patients who were asymptomatic before stavudine exposure, the risk of neuropathy following stavudine was 20% in younger, shorter patients, compared with 66% in older, taller individuals.Conclusions: Stavudine neuropathy risk increases with patient age and height. Prioritizing older and taller patients for alternative agents would be an inexpensive strategy to reduce neuropathy rates in countries where the burden of HIV disease limits treatment options. Neurology (R) 2009; 73: 315-320