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HIV neuropathy natural history cohort study: assessment measures and risk factors.
Neurology. 2006 Jun 13; 66(11):1679-87.Neur

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.

Authors+Show Affiliations

Mount Sinai Hospital, New York, NY, USA. david.simpson@mssm.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16769940

Citation

Simpson, D M., et al. "HIV Neuropathy Natural History Cohort Study: Assessment Measures and Risk Factors." Neurology, vol. 66, no. 11, 2006, pp. 1679-87.
Simpson DM, Kitch D, Evans SR, et al. HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology. 2006;66(11):1679-87.
Simpson, D. M., Kitch, D., Evans, S. R., McArthur, J. C., Asmuth, D. M., Cohen, B., Goodkin, K., Gerschenson, M., So, Y., Marra, C. M., Diaz-Arrastia, R., Shriver, S., Millar, L., & Clifford, D. B. (2006). HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology, 66(11), 1679-87.
Simpson DM, et al. HIV Neuropathy Natural History Cohort Study: Assessment Measures and Risk Factors. Neurology. 2006 Jun 13;66(11):1679-87. PubMed PMID: 16769940.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV neuropathy natural history cohort study: assessment measures and risk factors. AU - Simpson,D M, AU - Kitch,D, AU - Evans,S R, AU - McArthur,J C, AU - Asmuth,D M, AU - Cohen,B, AU - Goodkin,K, AU - Gerschenson,M, AU - So,Y, AU - Marra,C M, AU - Diaz-Arrastia,R, AU - Shriver,S, AU - Millar,L, AU - Clifford,D B, AU - ,, PY - 2006/6/14/pubmed PY - 2006/7/6/medline PY - 2006/6/14/entrez SP - 1679 EP - 87 JF - Neurology JO - Neurology VL - 66 IS - 11 N2 - 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. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/16769940/HIV_neuropathy_natural_history_cohort_study:_assessment_measures_and_risk_factors_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=16769940 DB - PRIME DP - Unbound Medicine ER -