Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV

Ronald J. Ellis, Monica Diaz, Ned Sacktor, Christina Marra, Ann C. Collier, David B. Clifford, Nigel Calcutt, Jerel A. Fields, Robert K. Heaton, Scott L. Letendre, Donald Franklin, Brookie Best, Debra Cookson, Clint Cushman, Matthew Dawson, Christine Fennema Notestine, Sara Gianella Weibel, Igor Grant, Thomas D. Marcotte, Jennifer Marquie-BeckFlorin Vaida, Vincent Rogalski, Susan Morgello, Letty Mintz, J. Allen McCutchan, Sher Storey, Benjamin Gelman, Eleanor Head, Mengesha Teshome

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. Methods: Ambulatory, community-dwelling HIV seropositive individuals were recruited at six research centers. Clinical evaluations at baseline and 12 years later determined neuropathy signs and distal neuropathic pain (DNP). Additional assessments measured activities of daily living and quality of life (QOL). Factors potentially associated with DSP and DNP progression included disease severity, treatment, demographics, and co-morbidities. Adjusted odds ratios were calculated for follow-up neuropathy outcomes. Results: Of 254 participants, 21.3% were women, 57.5% were non-white. Mean baseline age was 43.5 years. Polyneuropathy prevalence increased from 25.7% to 43.7%. Of 173 participants initially pain-free, 42 (24.3%) had incident neuropathic pain. Baseline risk factors for incident pain included unemployment (OR [95% CI], 5.86 [1.97, 17.4]) and higher baseline body mass index (BMI) (1.78 [1.03, 3.19] per 10-units). Participants with neuropathic pain at follow-up had significantly worse QOL and greater dependence in activities of daily living than those who remained pain-free. Interpretation: HIV DSP and neuropathic pain increased in prevalence and severity over 12 years despite high rates of viral suppression. The high burden of neuropathy included disability and poor life quality. However, substantial numbers remained pain-free despite clear evidence of neuropathy on exam. Protective factors included being employed and having a lower BMI. Implications for clinical practice include promotion of lifestyle changes affecting reversible risk factors.

Original languageEnglish
Pages (from-to)1166-1173
Number of pages8
JournalAnnals of Clinical and Translational Neurology
Issue number7
StatePublished - Jul 1 2020


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