Neuropathic Pain Is Common in People with HIV and Associated With Higher Levels of CSF NFL
Mohammadsobhan Sheikh Andalibi1, Scott Letendre2, Jennifer Iudicello3, Bin Tang3, Ronald J. Ellis1
1Neuroscience, 2Medicine, 3Psychiatry, University of California San Diego
Objective:
Examine the link between cerebrospinal fluid (CSF) and plasma inflammatory biomarkers and distal sensory polyneuropathy (DSP) and neuropathic pain (NPP) in people with HIV (PWH) and those without HIV (PWoH).
Background:
DSP is a debilitating chronic condition affecting PWH, even with viral suppression. Inflammation and neurodegeneration likely play roles in HIV-associated DSP and NPP, but limited research explores the connection between DSP and biomarkers of inflammation and neurodegeneration.
Design/Methods:
This cross-sectional study included 158 participants (102 PWH, 56 PWoH). DSP was defined as two or more of the following: symmetrical, bilateral, reduced distal vibratory and sharp sensation, and loss of ankle reflexes. DSP symptoms included NPP, sensation loss, and paresthesia. CSF neurofilament light (NFL) chain levels and plasma and CSF levels of other five biomarkers (interleukin-6, IP-10, MCP-1, soluble CD14, and soluble TNF receptor-II) were measured. We evaluated the association between DSP and biomarkers using logistic regression, controlling for age, gender, ethnicity, HIV serostatus, and cardiovascular disease risk, which have been shown previously to influence NPP, neurodegeneration, and inflammation.
Results:
The mean age was 44.7±12.9 years. PWH had a higher proportion of males (89.1% vs. 58.2%, p<0.001) and were more likely to have DSP and its symptoms (ps<0.05). No significant differences were observed in other demographic characteristics. Among PWH, 84.8% achieved viral suppression with a median CD4+ T-cell count of 694/µL (IQR 494-933). Elevated CSF NFL levels were associated with NPP (OR[95% CI]: 2.09[1.02-4.30] per unit change in log10-transformed NFL). When analyzed separately, PWH and PWoH showed no significant associations between plasma and CSF biomarkers and DSP signs and symptoms.
Conclusions:
NFL, a biomarker of axonal damage, was linked to NPP; future studies should evaluate whether neuroregenerative treatments might improve NPP. We found no associations between inflammatory biomarkers and DSP. Larger studies are needed to clarify the role of inflammatory biomarkers in HIV-associated DSP.