Background: The HIV pandemic leads to neurological impairments, which can manifest at any stage of the disease. The peripheral nervous system is often the most affected. Aim: To determine the prevalence and electroclinical profile of peripheral neuropathies (PNs) among PLHIV treated at the Brazzaville Outpatient Treatment Centre (OTC). Patients and Methods: A descriptive cross-sectional study was conducted from June to September 2021. Participants were PLHIV aged 18 years or older, on antiretroviral therapy (ART), with or without PN symptoms, in whom PN was confirmed by electroneuromyography (ENMG). Sociodemographic, anthropometric, clinical, and electrophysiological data were collected and analyzed using SPSS 28.0. Results: Among 62 patients who underwent ENMG, 50% presenting PN. Their mean age was 57.1 ± 8.9 years, and there was a female predominance (sex ratio = 0.7). Most were at HIV clinical stages 3 or 4, and all had undetectable viral load. Subjective neuropathic symptoms were reported in 19 (29.7%) patients; decreased osteotendinous reflexes were noted in 14 (87.5%) patients. ENMG findings showed that PN was symptomatic in 14 (43.7%) patients and subclinical in 18 (56.2%). The most frequently observed neuropathies were mononeuropathy (46.9%), particularly carpal tunnel syndrome (84.1%), and axonal sensory polyneuropathy (40.6%). Conclusions: Peripheral neuropathy is common among PLHIV, frequently presenting in a subclinical form. Early detection through detailed clinical history, thorough neurological examination, and systematic ENMG is crucial to optimizing overall HIV care.
References
[1]
Sissoko, M., Guirou, N., Bakayoko, S., Elien, G.R.R., Ballo, Y. and Sylla, F. (2020) Epidémiologie et étiologie des manifestations neurologiques au cours de l’infection à VIH dans le service de médecine interne du CHU du Point G. JACCR Africa, 4, 541-548.
[2]
UNAIDS (2020) Global HIV & AIDS Statistics—Fact Sheet. UNAIDS. https://www.unaids.org/fr/resources/fact-sheet
[3]
Swinkels, H.M., Justiz Vaillant, A.A., Nguyen, A.D., et al. (2024) HIV and AIDS. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK534860/
[4]
UNAIDS (2020) HIV and AIDS Estimates—Congo. UNAIDS. https://www.unaids.org/fr/regionscountries/countries/congo
[5]
McArthur, J.C., Brew, B.J. and Nath, A. (2005) Neurological Complications of HIV Infection. The Lancet Neurology, 4, 543-555. https://doi.org/10.1016/s1474-4422(05)70165-4
[6]
Millogo, A., Hare, D., Hema, A. and Sessouma, B. (2008) Les polyneuropathies chez les patients infectés par le vih à l’ère des antirétroviraux au chu de bobo-dioulasso (Burkina Faso). African Journal of Neurological Sciences, 27, 11-13. https://doi.org/10.4314/ajns.v27i1.7612
[7]
Simpson, D. (2002) Selected Peripheral Neuropathies Associated with Human Immunodeficiency Virus Infection and Antiretroviral Therapy. Journal of Neurovirology, 8, 33-41. https://doi.org/10.1080/13550280290167939
[8]
Puplampu, P., Ganu, V., Kenu, E., Kudzi, W., Adjei, P., Grize, L., et al. (2019) Peripheral Neuropathy in Patients with Human Immunodeficiency Viral Infection at a Tertiary Hospital in Ghana. Journal of NeuroVirology, 25, 464-474. https://doi.org/10.1007/s13365-019-00743-0
[9]
Adoukonou, T., Dassi-Gbenou, J., Glele, R.A., Dovonou, A., Kpangon, A. and Houinato, D. (2015) Épidémiologie des affections neurologiques dans une population de personnes vivant avec le VIH à Parakou en 2014. Revue Neurologique, 171, A136. https://doi.org/10.1016/j.neurol.2015.01.295
[10]
Mukoma, J.N., Matheri, J.M. and Tawa, N. (2020) Prevalence and Clinical Characteristics Associated with Peripheral Neuropathy Amongst Persons on HAART in Busia County, Kenya. South African Journal of Physiotherapy, 76, a1430. https://doi.org/10.4102/sajp.v76i1.1430
[11]
Ellis, R.J. (2010) Continued High Prevalence and Adverse Clinical Impact of Human Immunodeficiency Virus-Associated Sensory Neuropathy in the Era of Combination Antiretroviral Therapy. Archives of Neurology, 67, 552-558. https://doi.org/10.1001/archneurol.2010.76
[12]
Saylor, D., Nakigozi, G., Nakasujja, N., Robertson, K., Gray, R.H., Wawer, M.J., et al. (2017) Peripheral Neuropathy in HIV-Infected and Uninfected Patients in Rakai, Uganda. Neurology, 89, 485-491. https://doi.org/10.1212/wnl.0000000000004136
[13]
Simpson, D.M., Kitch, D., Evans, S.R., McArthur, J.C., Asmuth, D.M., Cohen, B., et al. (2006) HIV Neuropathy Natural History Cohort Study: Assessment Measures and Risk Factors. Neurology, 66, 1679-1687. https://doi.org/10.1212/01.wnl.0000218303.48113.5d
[14]
Stojkovic, T. (2006) Les neuropathies périphériques: Orientations et moyens diagnostiques. La Revue de Médecine Interne, 27, 302-312. https://doi.org/10.1016/j.revmed.2005.10.018
[15]
Evans, S.R., Ellis, R.J., Chen, H., Yeh, T., Lee, A.J., Schifitto, G., et al. (2011) Peripheral Neuropathy in HIV: Prevalence and Risk Factors. AIDS, 25, 919-928. https://doi.org/10.1097/qad.0b013e328345889d
[16]
Chen, H., Clifford, D.B., Deng, L., Wu, K., Lee, A.J., Bosch, R.J., et al. (2013) Peripheral Neuropathy in Art-Experienced Patients: Prevalence and Risk Factors. Journal of NeuroVirology, 19, 557-564. https://doi.org/10.1007/s13365-013-0216-4
[17]
Wondmagegn, H., Birhanu, A., Gebremickael, A., Esubalew, H., Birhanu, M. and Gembe, M. (2024) Peripheral Neuropathy and Associated Factors among Children Living with HIV on Antiretroviral Therapy in Gamo Zone, Southern Ethiopia: An Institution-Based Cross-Sectional Study. BMC Infectious Diseases, 24, Article No. 1059. https://doi.org/10.1186/s12879-024-09984-9
[18]
Adem, K.S., Janakiraman, B., Gebremeskel, B.F., Chala, M.B., Gelaw, A.Y. and Alemu, K. (2019) Epidemiology and Factors Associated with Peripheral Neuropathy among HIV Infected Patients in Gondar, Ethiopia: A Cross-Sectional Study. PLOS ONE, 14, e0211354. https://doi.org/10.1371/journal.pone.0211354
[19]
Schuldt, A.L., Bern, H., Hart, M., Gompels, M., Winston, A., Clarke, A., et al. (2023) Peripheral Neuropathy in Virologically Suppressed People Living with HIV: Evidence from the PIVOT Trial. Viruses, 16, Article 2. https://doi.org/10.3390/v16010002
[20]
Pardo, C.A., McArthur, J.C. and Griffin, J.W. (2001) HIV Neuropathy: Insights in the Pathology of HIV Peripheral Nerve Disease. Journal of the Peripheral Nervous System, 6, 21-27. https://doi.org/10.1046/j.1529-8027.2001.006001021.x
[21]
Phillips, T.J.C., Brown, M., Ramirez, J.D., Perkins, J., Woldeamanuel, Y.W., Williams, A.C.D.C., et al. (2014) Sensory, Psychological, and Metabolic Dysfunction in HIV-Associated Peripheral Neuropathy: A Cross-Sectional Deep Profiling Study. Pain, 155, 1846-1860. https://doi.org/10.1016/j.pain.2014.06.014
[22]
Ferrari, S., Vento, S., Monaco, S., Cavallaro, T., Cainelli, F., Rizzuto, N., et al. (2006) Human Immunodeficiency Virus-Associated Peripheral Neuropathies. Mayo Clinic Proceedings, 81, 213-219. https://doi.org/10.4065/81.2.213
[23]
Kabongo, J.K., Kaputu-Kalala-Malu, C., Luboya, O., Mutombo, V., Ntambwe, A., Mapatano, M.A., et al. (2015) Les neuropathies liées au VIH/SIDA: Une étude clinique chez les patients infectés par le VIH au Centre d’Excellence VIH/SIDA de l’Université de Lubumbashi. Pan African Medical Journal, 20, Article 392. https://doi.org/10.11604/pamj.2015.20.392.5799
[24]
Ndouongo, P.K., Ibole, J., Adoukonou, T., Oura, L., Assengone-Zeh, Y., Moubeka, M., et al. (2015) Prévalence et facteurs associés des polyneuropathies sensitives distales chez les personnes vivants avec le VIH (PVVIH) au centre hospitalier universitaire de Libreville. Revue Neurologique, 171, A142. https://doi.org/10.1016/j.neurol.2015.01.347
[25]
Wateba, M., Fiogbe, A., Assogba, K. and Tidjani, O. (2013) Prevalence des neuropathies peripheriques (NP) et leurs facteurs associes chez les patients sous traitement antiretroviral suivis dans le service des maladies infectieuses du CHU Sylvanus Olympio de Lome. Revue CAMES Santé, 1, 24-26.
[26]
Mpandzou, G., Bandzouzi, P.S., Diatewa, J., Kane, M., Moutoula-Latou, D., Kaba, Y., et al. (2022) Valeurs de référence des paramètres électroneuromyographiques du laboratoire de neurophysiologique clinique au centre hospitalier universitaire de Brazzaville. Health Sciences and Diseases, 23, 23-27.
[27]
Haute Autorité de Santé (2007) Prise en charge diagnostique des neuropathies périphériques (Polyneuropathies et mononeuropathies multiples), recommandations. HAS. https://www.has-sante.fr/jcms/c_598221/fr/prise-en-charge-diagnostique-des-neuropathies-peripheriques-polyneuropathies-et-mononeuropathies-multiples
[28]
Chavanet, P., Solary, E., Giroud, M., Waldner, A., Beuriat, P., Nordman, P., et al. (1989) Infraclinical Neuropathies Related to Immunodeficiency Virus Infection Associated with Higher T-Helper Cell Count. JAIDS Journal of Acquired Immune Deficiency Syndromes, 2, 564-569.
[29]
Konchalard, K. and Wangphonpattanasiri, K. (2007) Clinical and Electrophysiologic Evaluation of Peripheral Neuropathy in a Group of HIV-Infected Patients in Thailand. The Journal of the Medical Association of Thailand, 90, 774-781.
[30]
Mehta, S.A., Ahmed, A., Kariuki, B.W., Said, S., Omasete, F., Mendillo, M., et al. (2010) Implementation of a Validated Peripheral Neuropathy Screening Tool in Patients Receiving Antiretroviral Therapy in Mombasa, Kenya. The American Society of Tropical Medicine and Hygiene, 83, 565-570. https://doi.org/10.4269/ajtmh.2010.09-0629
[31]
Pillay, P., Wadley, A.L., Cherry, C.L., Karstaedt, A.S. and Kamerman, P.R. (2019) Clinical Diagnosis of Sensory Neuropathy in HIV Patients Treated with Tenofovir: A 6-Month Follow-Up Study. Journal of the Peripheral Nervous System, 24, 304-313. https://doi.org/10.1111/jns.12349
[32]
Gnonlonfoun, D., Agbétou, M., Goudjinou, G., Adoukonou, T.A., Adjien, K.C., Boumediene, F., et al. (2020) Les neuropathies périphériques au Bénin. Revue Neurologique, 176, S136. https://doi.org/10.1016/j.neurol.2020.01.016
[33]
Morgello, S. (2004) HIV-Associated Distal Sensory Polyneuropathy in the Era of Highly Active Antiretroviral Therapy. Archives of Neurology, 61, 546-551. https://doi.org/10.1001/archneur.61.4.546
[34]
Skopelitis, E.E., Kokotis, P.I., Kontos, A.N., Panayiotakopoulos, G.D., Konstantinou, K., Kordossis, T., et al. (2006) Distal Sensory Polyneuropathy in HIV-Positive Patients in the HAART Era: An Entity Underestimated by Clinical Examination. International Journal of STD & AIDS, 17, 467-472. https://doi.org/10.1258/095646206777689062
[35]
England, J.D., Gronseth, G.S., Franklin, G., Miller, R.G., Asbury, A.K., Carter, G.T., et al. (2005) Distal Symmetric Polyneuropathy: A Definition for Clinical Research: Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology, 64, 199-207. https://doi.org/10.1212/01.wnl.0000149522.32823.ea
[36]
Cruz Martínez, A. and Villoslada, C. (1991) Electrophysiologic Study in Peripheral Neuropathy Associated with HIV Infection. Electroencephalography and Clinical Neurophysiology, 31, 407-414.
[37]
Devigili, G., Tugnoli, V., Penza, P., Camozzi, F., Lombardi, R., Melli, G., et al. (2008) The Diagnostic Criteria for Small Fibre Neuropathy: From Symptoms to Neuropathology. Brain, 131, 1912-1925. https://doi.org/10.1093/brain/awn093
[38]
World Health Organization (WHO) (2021) Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach. WHO. https://www.who.int/publications/i/item/9789240031593
[39]
World Health Organization (WHO) (2007) WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease in Adults and Children. WHO. https://apps.who.int/iris/handle/10665/43699
[40]
Mbuya, S.O., Kwasa, T.O., Amayo, E.O., Kioy, P.G. and Bhatt, S.M. (1996) Peripheral Neuropathy in AIDS Patients at Kenyatta National Hospital. East African Medical Journal, 73, 538-540.
[41]
Cettomai, D., Kwasa, J.K., Birbeck, G.L., Price, R.W., Cohen, C.R., Bukusi, E.A., et al. (2013) Screening for HIV-Associated Peripheral Neuropathy in Resource-Limited Settings. Muscle & Nerve, 48, 516-524. https://doi.org/10.1002/mus.23795
[42]
Cettomai, D., Kwasa, J., Kendi, C., Birbeck, G.L., Price, R.W., Bukusi, E.A., et al. (2010) Utility of Quantitative Sensory Testing and Screening Tools in Identifying HIV-Associated Peripheral Neuropathy in Western Kenya: Pilot Testing. PLOS ONE, 5, e14256. https://doi.org/10.1371/journal.pone.0014256
[43]
Ngarka, L., Siewe Fodjo, J.N., Aly, E., Masocha, W. and Njamnshi, A.K. (2022) The Interplay between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa. Frontiers in Immunology, 12, Article 803475. https://doi.org/10.3389/fimmu.2021.803475
[44]
Jazebi, N., Evans, C., S. Kadaru, H., Kompella, D., Fang, F., Raji, M., et al. (2021) HIV-Related Neuropathy: Pathophysiology, Treatment and Challenges. Journal of Neurology and Experimental Neuroscience, 7, 15-24. https://doi.org/10.17756/jnen.2021-082
[45]
Mangus, L.M., Dorsey, J.L., Laast, V.A., Ringkamp, M., Ebenezer, G.J., Hauer, P., et al. (2014) Unraveling the Pathogenesis of HIV Peripheral Neuropathy: Insights from a Simian Immunodeficiency Virus Macaque Model. ILAR Journal, 54, 296-303. https://doi.org/10.1093/ilar/ilt047
[46]
Manfredi, R., Calza, L. and Chiodo, F. (2001) Carpal Tunnel Syndrome in HIV-Infected Patients Treated with Highly Active Antiretroviral Therapy: Other Case Reports. Rheumatology International, 21, 81-83. https://doi.org/10.1007/s002960100126
[47]
Mastroianni, A., Allegrini, F., Nardi, S., Donatucci, D., Girelli, F. and Guidi, C. (2017) Carpal Tunnel Syndrome in HIV-Positive Patients Coinfected with HCV. Reumatismo, 69, 164-169. https://doi.org/10.4081/reumatismo.2017.1010