ABSTRACT
BACKGROUND: In the era of highly active antiretroviral therapy, sensory neuropathies have increased in prevalence. We have documented the frequency and profile of the two most common forms of sensory neuropathies associated with Human Immunodeficiency Virus (HIV) infection and looked into clinicoelectrophysiological correlates to differentiate the two entities. METHODS: The study population comprised of all consecutive patients detected to be HIV positive and attending the Neurology outpatient department (from March 2011 to March 2012) who were aged ≥ 18 years and were able to give informed consent. The data were collected from the patient records (including CD4 counts and treatment details) and questionnaire based interview with each patient. All patients underwent detailed clinical examination and nerve conduction studies (NCSs). RESULTS: Among the total study population of 50 patients, there were 31 men and 19 women. Thirty two patients were in age range of 21 - 40 years and rest were above 40 years. 25 were on antiretroviral therapy (18 on regimen containing zidovudine; seven on regimen containing stavudine). The mean duration of antiretroviral therapy was 16.6±8.4 months. Low CD4 counts (<200) were noted in 24 patients (13 of these were on antiretroviral therapy). Clinically, the patients were classified as asymptomatic (n=34) and symptomatic (n=16). Among the symptomatic patients, nine were on antiretroviral therapy since less than one year (seven of these were on regimen containing stavudine). Ten patients aged more than 40-years had symptomatic neuropathy. No significant correlation was found between low CD4 counts and symptomatic neuropathy (p=0.21). Impaired vibration (100%) and absent ankle jerks (75%) were commoner than reduced pin sensitivity (46.6%). Twenty two patients had abnormal NCS results (18 of these were on antiretroviral therapy). Axonal distal symmetrical sensory neuropathy was the commonest pattern noted in 14 patients who were receiving antiretroviral therapy. Subclinical involvement as evidenced by abnormal NCSs was noted in 5 asymptomatic patients who were all on antiretroviral therapy. CONCLUSION: Symptomatic neuropathy was seen predominantly in HIV patients who were on antiretroviral therapy. All patients receiving stavudine containing regimen had severe symptomatic neuropathy within 1 year. There was an increase in the likelihood of symptomatic neuropathy among patients aged > 40 years. Subclinical neuropathy was common in those on antiretroviral therapy. Axonal neuropathy was the commonest pattern noted in patients who were receiving antiretroviral therapy and demyelinating neuropathy in patients not on antiretroviral therapy. Surprisingly no significant correlation was found between low CD4 counts and symptomatic neuropathy.
ABSTRACT
Background & Objectives: Low serum folate level is often reported as an adverse drug sequela of long term phenytoin usage seen with prolonged duration of phenytoin therapy. There is no previous study to prospectively track the serum folate level with usage of phenytoin, which is the objective of this study. Methods: Twenty-fi ve patients between the ages of 18-50 years diagnosed to have epilepsy and planning to start phenytoin were recruited in this study. Assessment of serum folic acid was done by chemiluminiscent method prior to the start of phenytoin and after 6 months of treatment. The serum folate level of 10 age and sex matched healthy control was also taken. Results: The average serum folate level was 7.48 + 2.04 ng/mL prior to the start of phenytoin therapy, which fell to 3.9 + 1.95 ng/mL after 6-month of phenytoin therapy (p-value <0.001). The average serum folate level for the age and sex matched 10 control samples was 14.46 + 2.81 ng/mL. Conclusion: A signifi cant fall of serum folic acid levels is seen in epilepsy patients after 6 months treatment with phenytoin.
