Peripheral Neuropathy in HIV-infected children attending Care and Treatment Clinic, at Muhimbili National Hospital, Dar es Salaam: A Cross sectional study
Abstract Background: Peripheral neuropathy (PN) is a neurological complication of untreated Human Immunodeficiency Virus (HIV) infection or exposure to antiretroviral drugs. Objectives: To determine the prevalence and associated factors for peripheral neuropathy among children living with HIV, attending Care and Treatment Clinic (CTC) at Muhimbili National Hospital (MNH).Materials and Methods: A cross-sectional study was conducted at MNH-CTC in Dar es Salaam between October - December 2019, where 383 HIV positive children aged 5 to 18 years were enrolled . Baseline characteristics were obtained from participant’s medical records at enrollment. Screening for peripheral neuropathy was done on each participant using the Pediatric modified Total Neuropathy Score (Ped m TNS) screening tool . Continuous variables were summarized as mean (± standard deviation) or median (Interquartile range) and differences compared using student t -test or Mann-Whitney U test. Categorical variables were summarized as frequencies and differences compared using chi square or Fisher’s exact test. Logistic regression models were applied to determine the independent predictors of peripheral neuropathy on multivariate analysis, reported as odds ratios (ORs) and 95% confidence intervals (CI). ResultsThe prevalence of peripheral neuropathy among HIV infected children was 14.1% (95% CI (10.8% - 18%). Common neuropathic presentation was numbness and tingling sensation, reduced ankle reflexes, loss of vibration sense and reduced light touch and sensation to pain limited to fingers and toes. Severe immunosuppression reflected by CD4 count < 200 cell/mm3 (OR=5.21; 95% CI 2.0 – 13.57; p = 0.001), high viremia ≥ 1000 copies/ml (OR=26.31; 95% CI 7.91 – 86.51; p <0.001), use of a combination regimen containing NRTI plus PI (OR= 5.67; 95% CI 2.11– 15.22; p = 0.01) and time interval of at least ≥ 6 months since last use of isoniazid (OR=3.35; 95% CI 1.41 – 7.91; p = 0.006) were independent predictors for peripheral neuropathy. ConclusionPeripheral neuropathy is common among HIV infected children attending CTC at MNH and its frequency increases with advanced disease. The choice of antiretroviral regimen and other medications with potentially neurotoxic effect should be carefully done. Early screening for peripheral neuropathy among HIV positive children should be done routinely in CTCs.