Factors associated with distal symmetric polyneuropathies in adult Zambians: A cross-sectional, observational study of the role of HIV, non-antiretroviral medication exposures, and nutrition

Abstract

Background: Non-antiretroviral (ART) drug exposures and poor nutrition may be important modifiable risk factors for distal symmetric polyneuropathies (DSP) in sub-Saharan Africa.

Methods: We conducted a cross-sectional study of DSP prevalence and factors associated with DSP among clinic attendees in urban and rural Zambia. All participants underwent neurologist-performed examination. Laboratory investigations seeking comorbid risk factors for DSP were performed for DSP cases.

Results: We identified 31/137 (22.6%) HIV+ and 21/177 (11.9%) HIV- DSP cases. DSP prevalence did not differ by urbanicity, although rural participants were significantly more likely to have one asymptomatic DSP sign. Low dietary diversity, history of syphilis, history of tuberculosis, and prior metronidazole and ciprofloxacin use were associated with DSP amongst HIV+ cases, while age and education were associated with DSP in HIV- participants (all p-values < 0·05). In a multivariate logistic regression model, HIV (p = 0·0001) and age (p < 0·0001), and ciprofloxacin exposure (p = 0·01) remained independently associated with DSP. While diabetes was rare, supoptimal micronutrients levels were common among DSP cases regardless of HIV status.

Conclusions: While HIV infection is strongly associated with DSP in Zambia, history of non-ART drug exposures and low dietary diversity are also important determinants of DSP in HIV+ individuals. Treatable micronutrient deficiencies were common.

Keywords: Africa; Epidemiology; HIV; Neuropathy; Nutrition.

Copyright © 2018 Elsevier B.V. All rights reserved.

Figures

Figure 1. Study Flow Chart

†ART-treated allowed at rural site due to low rates ART-naïve clinic attendees; ‡One DSP Sign=decreased vibratory sensation or decreased/absent Achilles reflexes present bilaterally in the absence of symptoms; §Meets AAN Case Definition for DSP; ††Participants with two DSP signs but no neuropathic symptoms and did not meet the AAN CCD. These patients were excluded from further analysis of factors associated with DSP; Abbreviations: VCT= Voluntary Testing & Counselling; ART= Antiretroviral; DSP=Distal Symmetric Polyneuropathy; NCS= Nerve Conduction Studies

Figure 2. Frequency of Symptoms and Signs among 52 DSP cases by HIV status

All p-values