Prevalence of peripheral neuropathy in injection drug users

Background: Nucleoside analogue reverse transcriptase inhibitors are a crit ical component of antiretroviral therapy in HIV-infected persons. Several o f these medications cause painful, dose-limiting peripheral neuropathy (PN) , which may develop earlier and more intensely in persons with preexisting neuropathy. The prevalence of baseline peripheral neuropathy in injection d rug users (IDUs), one of the largest populations of HIV-infected persons, h as not been described, yet has important implications for the selection of antiretroviral therapy. Methods: The authors performed a cross-sectional st udy of PN in 212 HIV-seronegative and HIV-seropositive IDUs using detailed neurologic histories, physical examinations, quantitative electrophysiologi c study, and quantitative sensory testing, Data were used to assign patient s to one of four positive categories of PN or one of two negative categorie s. Results: PN was present in 24.5% of HIV-seronegative IDUs, three to four times the reported frequency for HIV-seronegative persons in the general o r male homosexual population. PN was present in 32.1% of HIV-seropositive p atients. PN was axonal in nature and associated with increased age and alco hol use. PN was asymptomatic in 81% of HIV-seronegative and 71% of HIV-sero positive patients with PN. Conclusions: There is a high prevalence of PN in HIV-seronegative IDUs, Although these PNs do not seem to predispose HIV-se ropositive IDUs to HIV-related PN, they may increase the likelihood of iatr ogenic neuropathy. Intravenous drug users may need more diligent monitoring when administered nucleoside analogues than patients in risk groups with l ower endemic rates of PN.