Hiv Neuropathy Natural History Cohort Study: Assessment Measures and Risk Factors.
From: Mount Sinai Hospital, New York, NY, USA. david.simpson@mssm.edu
Neurology
- Publish Date: Jun 2006
- ISSN: 1526-632X
- Volume: 66
- Issue: 11
- Pages: 1679-87
- Medium: Internet
- Language: English
- Citation (JAMA): Simpson D M, Kitch D, Evans S R, et al. Hiv Neuropathy Natural History Cohort Study: Assessment Measures and Risk Factors.. Neurology Jun 2006;66:1679-87
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.
Mesh Headings (Keywords): Cohort 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
Check for Full Text / PubMed Unique Identifier (PMID): 16769940
This abstract is part of PubMed, a service of the U.S. National Library of Medicine. PubMed includes more than 17 million citations from MEDLINE and other life science journals for biomedical articles. See Copyright and Disclaimers.
Linked medical terms appearing on this page are added by Healia to help readers find more information and are not part of the original PubMed document.
The data herein was last updated on July 8th, 2008 and may not reflect the most current and accurate data available from NLM.