Optimizing measures of HIV‐associated neuropathy

Abstract

Introduction Distal symmetric polyneuropathy (DSP) is common in HIV and is associated with autonomic impairment. However tools to measure HIV-DSP do not include autonomic indices. We sought to optimize the Total Neuropathy Score (TNS) and the Composite Autonomic Severity Score (CASS) for use in HIV. Methods HIV-infected adults (n=102) underwent neurologic examination, quantitative sensory testing (QST), nerve conduction studies, and autonomic testing. Modifications of the TNS and CASS were assessed for validity based on correlation with the original measure and internal consistency. Results The TNS version commonly used in HIV-DSP is valid, but it is improved by elimination of QST and addition of autonomic indices. A modified version of the CASS (M-CASS) which was designed for sensitivity to milder impairment was also valid. Discussion A modified TNS that excludes QST and includes autonomic indices is optimal for HIV-DSP. The M-CASS is a valid measure of autonomic impairment in HIV.

Sympathetic function and markers of inflammation in well-controlled HIV

“…For each sub-score zero is normal, and increasing scores indicate declining function; as in prior work we defined HIV-AN as CASS ≥3 ( Robinson-Papp et al., 2013 ). Hyperadrenergic function is not captured by the CASS and so we also calculated BRSA from the VM data as previously described ( Schrezenmaier et al., 2007 ; Huang et al., 2007 ; Robinson-Papp et al., 2015 ). Since our main interest here was SNS function we considered the SNS markers in greater detail, focusing on BRSA, but also considering the following which comprise the CASS adrenergic sub-score: mean arterial pressure (MAP) and pulse pressure (PP) decline during phase 2 of the VM (with cut-off values of 20 ​mmHg for MAP decline and <0.5 for the ratio of lowest PP to baseline PP), failure of blood pressure to return to baseline during phase 2 of the VM, lack of a phase 4 blood pressure overshoot following VM and orthostatic hypotension on tilt table testing.…”

A Mixed-Methods Pilot Study of Mindfulness-Based Stress Reduction for HIV-Associated Chronic Pain

“…54 Perceived stress was quantified using the Perceived Stress Scale, which is a 10-item questionnaire which rates frequency of experiences such as feeling “nervous and stressed.” 56 Autonomic function was quantified using the Modified Composite Autonomic Severity Score (mCASS), which is calculated from the data obtained in the autonomic function testing as previously described. 57 However since the mCASS is designed to measure autonomic dysfunction, and may therefore not be sensitive to changes that remain within normal limits, we also examined other exploratory markers of autonomic function including: evoked sweat output, heart rate response to deep breathing, Valsalva ratio, resting heart rate, resting blood pressure, respiratory rate, and baroreflex sensitivity (adrenergic and vagal). 58 …”