A dissertation submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of MSc
(Med)
Johannesburg, 2011 / Peripheral sensory neuropathy is a common neurological complication of
antiretroviral therapy, typically occurring within 6-months of starting Highly Active
Antiretroviral Therapy (HAART) which includes stavudine. Therefore, the primary
aim of the study was to determine the 6-month incidence of ATN in patients free of
neuropathy and beginning stavudine-based HAART for the first time. Also, we
examined whether initiating stavudine-based HAART altered the symptoms of
patients who had a pre-existing, virus-mediated distal symmetrical polyneuropathy
(HIV-DSP). Seventy-five HIV-positive patients were screened for neuropathy, at the
Chris-Hani Baragwanath Hospital, using the AIDS Clinical Trials Group neuropathy
screening tool. The bilateral presence of atleast one sign (decreased vibration sense in
the great toe or absent ankle reflex) and one symptom (pain, paraesthesia or
numbness) in the feet was indicative of neuropathy. On recruitment, 52 patients
presented without neuropathy and 13 patients presented with HIV-DSP. After 3-
months of follow-up (n=46), 23% (10/46) of patients had developed peripheral
neuropathy, and by 6-months (n=44), 41% (18/44) of patients had developed
neuropathy. Greater disease severity was the only risk factor significantly associated
with the development of neuropathy. Eleven (61%) of the 18 patients that developed
neuropathy, developed painful symptomatic neuropathy, and only 6 (55%) of these
patients were receiving treatment for symptom relief. In patients with HIV-DSP,
numbness was the most common symptom reported at baseline and was the only
symptom to reduce in frequency across the 6-months. In conclusion, we found that
the development of neuropathy is common in the first 6-months of patients initiating
stavudine-based HAART.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13726 |
| Date | 11 February 2014 |
| Creators | Pillay, Prinisha |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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