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Severity of HIV-associated neuropathy is associated with plasma HIV-1 RNA levels

Simpson, David M.; Haidich, Anna-Bettinaa; Schifitto, Giovannib; Yiannoutsos, Constantin T.a; Geraci, Anthony P.; McArthur, Justin C.c; Katzenstein, David A.*; and the ACTG 291 study team

Clinical Science

Objective: To determine if there is an association between plasma HIV-1 RNA levels and severity of HIV-associated distal symmetrical polyneuropathy (DSP).

Design: Substudy of AIDS Clinical Trials Group Protocol 291, a double-blind, placebo-controlled study of recombinant human nerve growth factor for the treatment of painful DSP.

Methods: Two-hundred and thirty-six subjects had plasma HIV-1 RNA load assayed at baseline. Mean and maximum neuropathic pain was assessed once daily by the Gracely Pain Scale. Other measures included subjects’ global pain assessment and quantitative sensory tests (QST). These values were correlated with baseline HIV-1 RNA levels.

Results: Among 168 subjects with detectable plasma HIV-1 RNA, there was a significant correlation between plasma HIV-1 RNA and the severity of maximum and global pain, and toe cooling thresholds. Maximum and global pain assessment correlated with plasma HIV-1 RNA in individuals with detectable viral load (r, 0.162 and 0.194;P = 0.04 and 0.01, respectively).

Conclusions: There is an association between plasma HIV-1 RNA levels and the severity of pain and QST results in HIV-associated DSP. Further studies are needed to determine if aggressive use of antiretroviral drugs, including the use of dideoxynucleosides, may be of benefit to prevent or improve peripheral neuropathy.

From the Departments of Neurology and Clinical Neurophysiology, Mount Sinai School of Medicine, New York, New York, the a Harvard School of Public Health, Boston, Massachusetts, the b Department of Neurology, University of Rochester, New York, the c Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, Maryland, and the d Department of Medicine, Stanford University, California, USA. *See Appendix.

Requests for reprints to: D. M. Simpson, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1052, New York, NY 10029, USA.

Note: Presented in part at The Third International Symposium on NeuroVirology. San Francisco, September 2000.

Received: 6 July 2001;

revised: 21 September 2001; accepted: 26 September 2001.

Sponsorship: Supported by grants AI-38855 and AI-27668 from the National Institutes of Allergy and Infectious Diseases, RR00722 from the National Institutes of Health, NS02253 and NS32228 from the National Institute of Neurological Diseases and Stroke (Neurological AIDS Research Consortium), and 5 MO1 RR00071 from the National Center for Research Resources.

© 2002 Lippincott Williams & Wilkins, Inc.