Correlates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy.

TitleCorrelates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy.
Publication TypeJournal Article
Year of Publication2007
AuthorsZhou L, Kitch DW, Evans SR, Hauer P, Raman S, Ebenezer GJ, Gerschenson M, Marra CM, Valcour V, Diaz-Arrastia R, Goodkin K, Millar L, Shriver S, Asmuth DM, Clifford DB, Simpson DM, McArthur JC
Corporate AuthorsNARC and ACTG A5117 Study Group
JournalNeurology
Volume68
Issue24
Pagination2113-9
Date Published2007 Jun 12
ISSN1526-632X
KeywordsAction Potentials, Adult, Aged, Female, HIV Infections, Humans, Male, Middle Aged, Nerve Fibers, Neural Conduction, Neuralgia, Pain Measurement, Peripheral Nerves, Peripheral Nervous System Diseases, Phenotype, Prospective Studies, Sensory Receptor Cells, Skin, Sural Nerve
Abstract

OBJECTIVE: To demonstrate the relationship between epidermal nerve fiber density (ENFD) in the leg and the phenotype of HIV-associated distal sensory polyneuropathy (HIV-DSP) in a multicenter prospective study (ACTG A5117).

METHODS: A total of 101 HIV-infected adults, with CD4 cell count <300 cells/mm(3) and who had received antiretroviral therapy (ART) for at least 15 consecutive weeks, underwent standardized clinical and electrophysiologic assessment. All 101 subjects were biopsied at the distal leg (DL) and 99 at the proximal thigh (PT) at baseline. ENFD was assessed by skin biopsy using PGP9.5 immunostaining. Associations of ENFD with demographics, ART treatment, Total Neuropathy Score (TNS), sural sensory nerve action potential (SNAP) amplitude and conduction velocity, quantitative sensory testing (QST) measures, and neuropathic pain were explored.

RESULTS: ENFD at the DL site correlated with neuropathy severity as gauged by TNS (p < 0.01), the level of neuropathic pain quantified by the Gracely Pain Scale (GPS) (p = 0.01) and Visual Analogue Scale (VAS) (p = 0.01), sural SNAP amplitude (p < 0.01), and toe cooling (p < 0.01) and vibration (p = 0.02) detection thresholds. ENFD did not correlate with neurotoxic ART exposure, CD4 cell count, or plasma HIV-1 viral load.

CONCLUSIONS: In subjects with advanced HIV-1 infection, epidermal nerve fiber density (ENFD) assessment correlates with the clinical and electrophysiologic severity of distal sensory polyneuropathy (DSP). ENFD did not correlate with previously established risk factors for HIV-DSP, including CD4 cell count, plasma HIV-1 viral load, and neurotoxic antiretroviral therapy exposure.

DOI10.1212/01.wnl.0000264888.87918.a1
Alternate JournalNeurology
PubMed ID17562831
Grant ListAI34853 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
K24 NS002253 / NS / NINDS NIH HHS / United States
NS02253 / NS / NINDS NIH HHS / United States
NS32228 / NS / NINDS NIH HHS / United States
NS44807 / NS / NINDS NIH HHS / United States
RR00071 / RR / NCRR NIH HHS / United States
RR16467 / RR / NCRR NIH HHS / United States