HIV neuropathy natural history cohort study: assessment measures and risk factors.

TitleHIV neuropathy natural history cohort study: assessment measures and risk factors.
Publication TypeJournal Article
Year of Publication2006
AuthorsSimpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B, Goodkin K, Gerschenson M, So Y, Marra CM, Diaz-Arrastia R, Shriver S, Millar L, Clifford DB
Corporate AuthorsACTG A5117 Study Group
JournalNeurology
Volume66
Issue11
Pagination1679-87
Date Published2006 Jun 13
ISSN1526-632X
KeywordsCohort Studies, Comorbidity, Female, HIV Infections, Humans, Incidence, Male, Middle Aged, Outcome Assessment (Health Care), Polyneuropathies, Risk Assessment, Risk Factors, Sensation Disorders, Severity of Illness Index, United States
Abstract

BACKGROUND: Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy.

METHODS: The authors evaluated 101 subjects with advanced HIV infection over 48 weeks. Assessments included a brief peripheral neuropathy (PN) screen (BPNS), neurologic examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsies with quantitation of epidermal nerve fiber density. Data were summed into a Total Neuropathy Score (TNS). The presence, severity, and progression of DSP were related to clinical and laboratory results.

RESULTS: The mean TNS (range 0 to 36) was 8.9, with 38% of subjects classified as PN-free, 10% classified as having asymptomatic DSP, and 52% classified as having symptomatic DSP. Progression in TNS from baseline to week 48 occurred only in the PN-free group at baseline (mean TNS change = 1.16 +/- 2.76, p = 0.03). Factors associated with progression in TNS were lower current TNS, distal epidermal denervation, and white race. As compared with the TNS diagnosis of PN at baseline, the BPNS had a sensitivity of 34.9% and a specificity of 89.5%.

CONCLUSIONS: In this cohort of advanced human immunodeficiency virus (HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy (DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.

DOI10.1212/01.wnl.0000218303.48113.5d
Alternate JournalNeurology
PubMed ID16769940
Grant ListAI 46386 / AI / NIAID NIH HHS / United States
AI-25859 / AI / NIAID NIH HHS / United States
AI03855 / AI / NIAID NIH HHS / United States
AI046376 / AI / NIAID NIH HHS / United States
AI25903 / AI / NIAID NIH HHS / United States
AI27658 / AI / NIAID NIH HHS / United States
AI27664 / AI / NIAID NIH HHS / United States
AI27668 / AI / NIAID NIH HHS / United States
AI27670 / AI / NIAID NIH HHS / United States
AI32770 / AI / NIAID NIH HHS / United States
AI34853 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
AI46370 / AI / NIAID NIH HHS / United States
K24 NS002253 / NS / NINDS NIH HHS / United States
NS032228 / NS / NINDS NIH HHS / United States
NS44807 / NS / NINDS NIH HHS / United States
RR-00071 / RR / NCRR NIH HHS / United States
RR00044 / RR / NCRR NIH HHS / United States
RR00051 / RR / NCRR NIH HHS / United States
RR00522 / RR / NCRR NIH HHS / United States
RR016467 / RR / NCRR NIH HHS / United States