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Chronic Distal Sensory Polyneuropathy Is a Major Contributor to Balance Disturbances in Persons Living With HIV

Sakabumi, Duaa Z., MBBSa; Moore, Raeanne C., PhDb,c; Tang, Bin, PhDd; Delaney, Patrick A., MDc; Keltner, John R., MD, PhDb,c,d; Ellis, Ronald J., MD, PhDc,e,d

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15, 2019 - Volume 80 - Issue 5 - p 568–573
doi: 10.1097/QAI.0000000000001953
Clinical Science

Background: Medical comorbidities accumulate in older persons living with HIV (PLWH), causing disability and reduced quality of life. Sensory neuropathy and polypharmacy may contribute to balance difficulties and falls. The contribution of neuropathy is understudied.

Objective: To evaluate the contribution of chronic distal sensory polyneuropathy (cDSPN) to balance disturbances among PLWH.

Methods: Ambulatory PLWH and HIV− adults (N = 3379) were prospectively studied. All participants underwent a neurologic examination to document objective abnormality diagnostic of cDSPN and reported neuropathy symptoms including pain, paresthesias, and numbness. Participants provided detailed information regarding balance disturbance and falls over the previous 10 years. Balance disturbances were coded as minimal or none and mild-to-moderate. Covariates included age, HIV disease, and treatment characteristics and medications (sedatives, opioids, and antihypertensives).

Results: Eleven percent of participants reported balance disturbances at some time during the last 10 years; the rate in PLWH participants exceeding that for HIV− [odds ratio 2.59, 95% confidence interval: 1.85 to 3.64]. Fifty-two percent met criteria for cDSPN. Balance problems were more common in those with cDSPN [odds ratio = 3.3 (2.6–4.3)]. Adjusting for relevant covariates, balance disturbances attributable to cDSPN were more frequent among HIV+ than HIV− (interaction P = 0.001). Among individuals with cDSPN, older participants were much more likely to report balance disturbances than younger ones.

Conclusions: cDSPN contributes to balance problems in PLWH. Assessments of cDSPN in older PLWH should be a clinical priority to identify those at risk and to aid in fall prevention and the ensuing consequences, including bone fractures, subdural hematoma, hospital admissions, and fatal injury.

aHealth Sciences International, University of California, San Diego, San Diego, CA;

bDepartment of Psychiatry, University of California, La Jolla, CA;

cVA San Diego Healthcare System, San Diego, CA;

dHIV Neurobehavioral Research Centre, San Diego, CA; and

eDepartment of Neurosciences, University of California, La Jolla, CA

Correspondence to: Ronald J. Ellis, MD, PhD, HIV Neurobehavioral Research Program, University of California, San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA 92103-8231 (e-mail:

Supported by the National Institute of Health and the National Institute of Mental Health [NIMH P30 MH062512, U24 MH100928, N01 MH22005, HHSN271201000036C, HHSN271201000030C, R01 MH107345, R01 MH073419, NIDA P50 DA026306, P01 DA012065]. The HIV Neurobehavioral Research Center (HNRC) is supported by Center award P30MH062512 from NIMH. D.Z.S. was supported by the UC San Diego Health Sciences International Bridge to Residency Clinical Research Scholarship Program. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.

The authors have no funding or conflicts of interest to disclose.

Received September 04, 2018

Accepted December 03, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.