Low-dose zalcitabine-related toxic neuropathy: Frequency, natural history, and risk factors

A. S. Blum, G. J. Dal Pan, J. Feinberg, C. Raines, K. Mayjo, David Cornblath, Justin Charles McArthur

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Abstract

We studied the features and frequency of sensory neuropathy among 79 HIV- 1-infected individuals participating in a multicenter clinical trial of zalcitabine (2'3'-dideoxycytidine, or ddC) antiretroviral therapy. The trial compared zalcitabine monotherapy (2.25 mg/day) versus combination therapy (2.25 mg/day ddC) with zidovudine (ZDV, formerly AZT) versus monotherapy with ZDV alone. Neuropathy developed in 34% of ddC recipients but in only 4% of comparable patients treated with ZDV alone-a 7.9-fold increase in the attack rate of neuropathy. Using risk factor analysis, we found that diabetes mellitus was significantly associated with the development of toxic neuropathy (p = 0.02), and weight loss may contribute to its appearance. Like HIV-associated sensory neuropathy, ddC-related toxic neuropathy is a predominantly sensory, length-dependent, symmetric, painful neuropathy. Dose reduction lessened the severity of symptoms, although objective signs of neuropathy persisted. Patients with subclinical neuropathies or significant neuropathy risks such as diabetes may be poor candidates for ddC therapy.

Original languageEnglish (US)
Pages (from-to)999-1003
Number of pages5
JournalNeurology
Volume46
Issue number4
Publication statusPublished - Apr 1996

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ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Blum, A. S., Dal Pan, G. J., Feinberg, J., Raines, C., Mayjo, K., Cornblath, D., & McArthur, J. C. (1996). Low-dose zalcitabine-related toxic neuropathy: Frequency, natural history, and risk factors. Neurology, 46(4), 999-1003.