J.A.P. and G.J. contributed equally to this study.
Sensory neuropathy in human immunodeficiency virus/acquired immunodeficiency syndrome patients: Protease inhibitor–mediated neurotoxicity
Article first published online: 21 APR 2006
Copyright © 2006 American Neurological Association
Annals of Neurology
Volume 59, Issue 5, pages 816–824, May 2006
How to Cite
Pettersen, J. A., Jones, G., Worthington, C., Krentz, H. B., Keppler, O. T., Hoke, A., Gill, M. J. and Power, C. (2006), Sensory neuropathy in human immunodeficiency virus/acquired immunodeficiency syndrome patients: Protease inhibitor–mediated neurotoxicity. Ann Neurol., 59: 816–824. doi: 10.1002/ana.20816
- Issue published online: 21 APR 2006
- Article first published online: 21 APR 2006
- Manuscript Accepted: 7 JAN 2006
- Manuscript Revised: 3 JAN 2006
- Manuscript Received: 14 SEP 2005
- Canadian Institutes for Health Research (CIHR)
- NIH (National Institute of Neurological Disorders and Stroke). Grant Numbers: IR 01NS4626201, R00051-B
- CIHR Fellowship
- Canada Research Chair (Tier 1) in Neurological Infection and Immunity
Human immunodeficiency virus–associated sensory neuropathy (HIV-SN) is a common and disabling disorder, often associated with antiretroviral therapy (ART) use. We investigated the clinical features and associated pathogenic determinants of HIV-SN in a neurological cohort of HIV-infected patients, together with a novel model of HIV-SN.
HIV-infected patients with neurological disease were investigated in terms of clinical and laboratory aspects together with ART exposure focusing on symptomatic HIV-SN. Rat-derived dorsal root ganglion (DRG) cultures, transgenic for human CD4 and CCR5 treated with ARTs or HIV infected, or both, were studied with respect to quantitative neuronal injury.
Among 221 patients assessed from 1998 to 2004, 120 had no sensory neuropathy, whereas 101 displayed HIV-SN, including 64 with distal sensory neuropathy and 37 with antiretroviral toxic neuropathy. HIV-SN patients exhibited significantly greater mean age, peak plasma viral loads, and exposure to neurotoxic dideoxynucleosides and protease inhibitors, including indinavir, saquinavir, or ritonavir. HIV-infected DRG cultures exposed to indinavir or didanosine showed significant neuronal atrophy, neurite retraction, and process loss, compared with controls. Indinavir was selectively cytotoxic to DRG macrophages compared with other ARTs.
Protease inhibitor exposure is an unrecognized risk factor for the development of HIV-SN, which may potentiate neuronal damage in HIV-infected DRGs, possibly through the loss of macrophage-derived trophic factors. Ann Neurol 2006;59:816–824