@article{64535eac80ad497298f2b05acdb64c94,
title = "Isoniazid exposure and pyridoxine levels in human immunodeficiency virus associated distal sensory neuropathy",
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.",
keywords = "Acetylation, NAT2, Nutrition, Tuberculosis, Vitamin B6",
author = "{Van Der Watt}, {J. J.} and Benatar, {Michael G} and Harrison, {T. B.} and H. Carrara and Heckmann, {J. M.}",
year = "2015",
month = nov
day = "1",
doi = "10.5588/ijtld.15.0467",
language = "English (US)",
volume = "19",
pages = "1312--1319",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "11",
}