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

TitleChronic Distal Sensory Polyneuropathy Is a Major Contributor to Balance Disturbances in Persons Living With HIV.
Publication TypeJournal Article
Year of Publication2019
AuthorsSakabumi, DZ, Moore, RC, Tang, B, Delaney, PA, Keltner, JR, Ellis, RJ
JournalJ Acquir Immune Defic Syndr
Date Published2019 04 15
KeywordsCase-Control Studies, Female, HIV Infections, Humans, Internal, Male, Middle Aged, Polyneuropathies, Postural Balance, Prospective Studies, Sensation Disorders

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.

Alternate JournalJ Acquir Immune Defic Syndr
PubMed ID30649035
PubMed Central IDPMC6482029
Grant ListK23 MH107260 / MH / NIMH NIH HHS / United States
K23 NS079311 / NS / NINDS NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
R01 AG062387 / AG / NIA NIH HHS / United States