Abstract
SETTING: Distal sensory polyneuropathy (DSP) may manifest in human immunodeficiency virus (HIV) infected individuals before or after antiretroviral therapy (ART). DSP can also occur in response to isoniazid (INH); this can be prevented by pyridoxine supplementation. N-acetyltransferase 2 (NAT2) polymorphisms influence drug acetylation and possibly the risk for INHassociated DSP. OBJECTIVE : To investigate the relationship between previous/current TB, pyridoxine deficiency and DSP in HIV-infected individuals enrolled in a governmentsponsored HIV programme. D E S I G N : Neuropathy assessments were performed among 159 adults pre-ART and 12 and 24 weeks thereafter. DSP was defined as ≥1 neuropathic symptom and sign. NAT2 genotypes predicted acetylation phenotype. Serum pyridoxine levels (PLP) were quantified at baseline and week 12. RESULT S : DSP was present in 16% of individuals pre- ARTand was associated with previous/current TB (P= 0.020). Over 50% were pyridoxine deficient (PLP <25 nmol/l), despite supplementation with vitamin B complex supplements (2-4 mg/day pyridoxine). Those with a history of TB and pre-ART DSP were more likely to be pyridoxine deficient (P=0.029), and slow/ intermediate NAT2 phenotypes impacted on their PLP levels. Incident/worsening DSP after ART developed in 21% of the participants. PLP levels remained low after ART, particularly among those with prior TB, but without an association between DSP or NAT2 phenotypes. CONCLUS ION: Adequate pyridoxine supplementation before ART initiation should be prioritised, particularly in those with a history of TB or current TB.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1312-1319 |
| Number of pages | 8 |
| Journal | International Journal of Tuberculosis and Lung Disease |
| Volume | 19 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2015 |
Fingerprint
Keywords
- Acetylation
- NAT2
- Nutrition
- Tuberculosis
- Vitamin B6
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Infectious Diseases
Cite this
Isoniazid exposure and pyridoxine levels in human immunodeficiency virus associated distal sensory neuropathy. / Van Der Watt, J. J.; Benatar, Michael G; Harrison, T. B.; Carrara, H.; Heckmann, J. M.
In: International Journal of Tuberculosis and Lung Disease, Vol. 19, No. 11, 01.11.2015, p. 1312-1319.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Isoniazid exposure and pyridoxine levels in human immunodeficiency virus associated distal sensory neuropathy
AU - Van Der Watt, J. J.
AU - Benatar, Michael G
AU - Harrison, T. B.
AU - Carrara, H.
AU - Heckmann, J. M.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - SETTING: Distal sensory polyneuropathy (DSP) may manifest in human immunodeficiency virus (HIV) infected individuals before or after antiretroviral therapy (ART). DSP can also occur in response to isoniazid (INH); this can be prevented by pyridoxine supplementation. N-acetyltransferase 2 (NAT2) polymorphisms influence drug acetylation and possibly the risk for INHassociated DSP. OBJECTIVE : To investigate the relationship between previous/current TB, pyridoxine deficiency and DSP in HIV-infected individuals enrolled in a governmentsponsored HIV programme. D E S I G N : Neuropathy assessments were performed among 159 adults pre-ART and 12 and 24 weeks thereafter. DSP was defined as ≥1 neuropathic symptom and sign. NAT2 genotypes predicted acetylation phenotype. Serum pyridoxine levels (PLP) were quantified at baseline and week 12. RESULT S : DSP was present in 16% of individuals pre- ARTand was associated with previous/current TB (P= 0.020). Over 50% were pyridoxine deficient (PLP <25 nmol/l), despite supplementation with vitamin B complex supplements (2-4 mg/day pyridoxine). Those with a history of TB and pre-ART DSP were more likely to be pyridoxine deficient (P=0.029), and slow/ intermediate NAT2 phenotypes impacted on their PLP levels. Incident/worsening DSP after ART developed in 21% of the participants. PLP levels remained low after ART, particularly among those with prior TB, but without an association between DSP or NAT2 phenotypes. CONCLUS ION: Adequate pyridoxine supplementation before ART initiation should be prioritised, particularly in those with a history of TB or current TB.
AB - SETTING: Distal sensory polyneuropathy (DSP) may manifest in human immunodeficiency virus (HIV) infected individuals before or after antiretroviral therapy (ART). DSP can also occur in response to isoniazid (INH); this can be prevented by pyridoxine supplementation. N-acetyltransferase 2 (NAT2) polymorphisms influence drug acetylation and possibly the risk for INHassociated DSP. OBJECTIVE : To investigate the relationship between previous/current TB, pyridoxine deficiency and DSP in HIV-infected individuals enrolled in a governmentsponsored HIV programme. D E S I G N : Neuropathy assessments were performed among 159 adults pre-ART and 12 and 24 weeks thereafter. DSP was defined as ≥1 neuropathic symptom and sign. NAT2 genotypes predicted acetylation phenotype. Serum pyridoxine levels (PLP) were quantified at baseline and week 12. RESULT S : DSP was present in 16% of individuals pre- ARTand was associated with previous/current TB (P= 0.020). Over 50% were pyridoxine deficient (PLP <25 nmol/l), despite supplementation with vitamin B complex supplements (2-4 mg/day pyridoxine). Those with a history of TB and pre-ART DSP were more likely to be pyridoxine deficient (P=0.029), and slow/ intermediate NAT2 phenotypes impacted on their PLP levels. Incident/worsening DSP after ART developed in 21% of the participants. PLP levels remained low after ART, particularly among those with prior TB, but without an association between DSP or NAT2 phenotypes. CONCLUS ION: Adequate pyridoxine supplementation before ART initiation should be prioritised, particularly in those with a history of TB or current TB.
KW - Acetylation
KW - NAT2
KW - Nutrition
KW - Tuberculosis
KW - Vitamin B6
UR - http://www.scopus.com/inward/record.url?scp=84945588748&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84945588748&partnerID=8YFLogxK
U2 - 10.5588/ijtld.15.0467
DO - 10.5588/ijtld.15.0467
M3 - Article
C2 - 26467583
AN - SCOPUS:84945588748
VL - 19
SP - 1312
EP - 1319
JO - International Journal of Tuberculosis and Lung Disease
JF - International Journal of Tuberculosis and Lung Disease
SN - 1027-3719
IS - 11
ER -