[Clinical and subclinical neuropathy in patients with human immunodeficiency virus receiving antiretroviral therapy]. / Neuropatía clínica y subclínica de pacientes con virus de inmunodeficiencia humana en tratamiento antirretroviral.

INTRODUCTION: There is a clear association between human immunodeficiency virus (HIV) and peripheral neuropathy. Peripheral polyneuropathy (PPN) is the most frequent neurological complication due to both the infection itself and the neurotoxicity deriving from highly active antiretroviral therapies (HAART). AIMS: The aim of this study was to determine the incidence of symptomatic PPN associated to HAART and to find out the true prevalence rate of subclinical neuropathy following over several years' treatment. PATIENTS AND METHODS: In order to evaluate the incidence of symptomatic PPN we conducted a study of patients undergoing treatment with HAART with a combination of didanosine (ddI), lamivudine (3TC) and efavirenz, and its presence was confirmed both clinically and electromyographically. Moreover, to study the prevalence rate of asymptomatic or subclinical PPN we chose patients without PPN who had been receiving this treatment for more than two years, with a viral load that had remained undetectable for over a year and with no further risk factors for PPN, and submitted them to a voluntary electromyographic study for PPN. RESULTS: Of the 108 patients studied, only two cases of symptomatic PPN were found. CONCLUSIONS: The incidence rate of clinical neuropathy following the administration of HAART is low (1.85%); PPN is a rare cause of withdrawal. Nevertheless, the prevalence rate found for subclinical PPN in patients undergoing prolonged therapy is high (66%). We therefore find ourselves with a problem that is little known, rarely suspected and more common than is believed.

Neuropatía clínica y subclínica de pacientes con virus de inmunodeficiencia humana en tratamiento antirretroviral / Clinical and subclinical neuropathy in patients with human immunodeficiency virus receiving antiretroviral therapy

Introducción. Existe una clara asociación entre el virus de inmunodeficiencia humana y la neuropatía periférica. La polineuropatía periférica (PNP) es la complicación neurológica más frecuente, debido tanto a la propia infección como a la neurotoxicidad derivada de las terapias antirretrovirales de gran actividad(TARGA). Objetivo. Esclarecer la incidencia de la PNP sintomática asociada a las TARGA y conocer la verdadera prevalencia de neuropatía subclínica tras un tratamiento prolongado de varios años. Pacientes y métodos. Para valorar la incidencia de la PNP sintomática se realizó un estudio de los pacientes en tratamiento con TARGA con la combinación de didanosina (ddI), la mivudina (3TC) y efavirenz, y se definió su presencia a la confirmación clínica y electromiográfica. Por otra parte, con la finalidad de estudiarla prevalencia de la PNP asintomática o subclínica se escogieron pacientes sin PNP que llevaban más de dos años con dicho tratamiento, con una carga viral indetectable durante más de un año y sin otros factores de riesgo de padecer PNP, y se les realizó de forma voluntaria un estudio electromiográfico para PNP. Resultados. De los 108 pacientes estudiados, tan sólo se objetivaron dos casos de PNP sintomática. Conclusiones. La incidencia de neuropatía clínica tras la administración de TARGA es baja (1,85%); la PNP es una causa poco frecuente de suspensión. Sin embargo, la prevalencia encontrada de PNP subclínica en pacientes con terapia prolongada es alta (66%), con lo que nos encontramos con un problema poco conocido, poco sospechado y más frecuente de lo que se cree (AU)

Introduction. There is a clear association between human immunodeficiency virus (HIV) and peripheral neuropathy. Peripheral polyneuropathy (PPN) is the most frequent neurological complication due to both the infection itself and the neurotoxicity deriving from highly active antiretroviral therapies (HAART). Aims. The aim of this study was to determine the incidence of symptomatic PPN associated to HAART and to find out the true prevalence rate of subclinical neuropathy following over several years’ treatment. Patients and methods. In order to evaluate the incidence of symptomatic PPN we conducted a study of patients undergoing treatment with HAART with a combination of didanosine (ddI), lamivudine(3TC) and efavirenz, and its presence was confirmed both clinically and electromyographically. Moreover, to study the prevalence rate of asymptomatic or subclinical PPN we chose patients without PPN who had been receiving this treatment for more than two years, with a viral load that had remained undetectable for over a year and with no further risk factors for PPN, and submitted them to a voluntary electromyography study for PPN. Results. Of the 108 patients studied, only two cases of symptomatic PPN were found. Conclusions. The incidence rate of clinical neuropathy following the administration of HAART is low (1.85%); PPN is a rare cause of withdrawal. Nevertheless, the prevalence rate found for subclinical PPN in patients undergoing prolonged therapy is high (66%). We therefore find ourselves with a problem that is little known, rarely suspected and more common than is believed (AU)