Lower limb
neuropathic pain in HIV patients is a common manifestation of sensory neuropathy (HIV-SN), but can be seen in patients who do not meet standard definitions of HIV-SN. The drug
stavudine is a risk factor for HIV-SN, but some patients treated without
stavudine experience HIV-SN, and the prevalence and risk factors influencing
neuropathic pain in this setting are unknown. A cross sectional study at Cipto Mangunkusumo Hospital Jakarta tested 197 HIV patients treated for >12 months without
stavudine. HIV-SN was defined using the
AIDS Clinical Trial Group Brief
Peripheral Neuropathy Screening Test (ACTG-BPNST). A validated Indonesia translation of Douleur Neuropathique en 4 (DN4) questionnaire was used to assess lower limb
neuropathic pain. Nerve conduction studies assessed large nerve fiber function and Stimulated Skin Wrinkle (SSW) tests were performed to assess small nerve fibers. The prevalence of
neuropathic pain was 6.6%. BPNST+HIV-SN was diagnosed in 14.2% of the cohort and 38.5% of patients with
pain. Use of
protease inhibitors and ART duration <2 years associated with
neuropathic pain in univariate (p = .036, p = .002, resp.) and multivariable analyses (model p < .001). SSW tests were abnormal in 53.8% of subjects with
neuropathic pain and only 25.5% without
pain (p = .05). Patients with
pain without BPNST+HIV-SN had begun ART more recently than those with both diagnoses. Overall this preliminary study showed that
neuropathic pain associated with
protease inhibitors and a shorter duration of ART in Indonesian HIV patients, and may be an early symptom of
small fiber neuropathy in this context.