Distal Sensory Polyneuropathy among HIV Patients in Libreville in Gabon

Abstract

Distal sensory polyneuropathy (DSP) was more frequent among Human Immunodeficiency Virus (HIV) patients. The reliable tool for its diagnosis is not available everywhere in sub-Saharan Africa. We aimed to estimate the frequency of DSP among HIV patients in Libreville. We’ve conducted a cross-sectional study including all consecutives HIV-patients admitted to the HIV clinic in the University Teaching Hospital of Libreville (Gabon) between 1 May and 31 July 2014. All patients underwent a full neurological examination doing by two neurologists. The diagnosis of DSP was based on Brief Peripheral Neuropathy Screen (BPNS). We also collected the data concerning past medical history, the use of neurotoxic drug, history of disease and data of High Active Antiretroviral Therapy (HAART). The logistic regression was used to study the factors associated with DSP. They were 620 patients aged from 17 to 74 years with the mean age of 42.1 years ± 11.0 years and 570 (91.9%) were on HAART. The mean duration of disease was 57.6 ± 42.5 months. Among the 620 patients 170 fulfilled criteria for DSP, and the overall frequency of DSP was 27.4%. The associated factors in univariate analysis were the age, the occupation, the use of HAART, the HAART option, the stage of the disease, opportunistic disease, alcohol consumption, exposure to isoniazid, diabetes mellitus and the modes of contamination. But in multivariate analysis the associated factors were the stage of disease OR 2.7 [1.2 - 3.7], diabetes mellitus OR 2.4 [1.4 - 5.8] and the use of D4T in HAART OR 1.9 [1.1 - 4.9]. The main symptoms among the patients were burning feet (47.6%), the tingling (40.0%), numbness (27.6%), alteration of ankle reflex (87.6%) and alteration of vibration sensation (27.6%). The DSP was more frequent among HIV patients and could be explained by the duration of the disease, the association with metabolic disease and the use of D4T.