Screening for HIV‐associated peripheral neuropathy in resource‐limited settings

Abstract

INTRODUCTION Peripheral neuropathy is the most common neurological complication of HIV but is widely under-diagnosed in resource-limited settings. We investigated the utility of screening tools administered by non-physician health care workers (HCW) and quantitative sensory testing (QST) administered by trained individuals for identification of moderate/severe neuropathy. METHODS We enrolled 240 HIV-infected outpatients using two-stage cluster randomized sampling. HCWs administered the several screening tools. Trained study staff performed QST. Tools were validated against a clinical diagnosis of neuropathy. RESULTS Participants were 65% women, mean age 36.4 years, median CD4 324 cells/μL. 65% were taking antiretrovirals, and 18% had moderate/severe neuropathy. The screening tests were 76% sensitive in diagnosing moderate/severe neuropathy with negative predictive values of 84–92%. QST was less sensitive but more specific. DISCUSSION Screening tests administered by HCW have excellent negative predictive values and are promising tools for scale-up in resource-limited settings. QST shows promise for research use.

Diagnostic Test of Polyneuropathy Score, 10-G Semmes Wenstein Monofilament (Swm) and Vibration Perception Treshold (Vpt)-Quantitative Sensory Testing (Qst) in Distal Sensory Polyneuropathy (Dsp)-Human Immunodeficiency Virus (Hiv)

“…Meanwhile BPNS AUC from the research were at 0.553-0.554. 35 The different diagnostic test result were possibly due to substantial difference in sample size. This research sample size is 77 patients while research by Cettomai, et.…”

“…The values for HIV-DSP diagnostic test for monofilament test are as follows: sensitivity is 66%, 86% specificity, 84% positive predictive value, 69% negative predictive value, positive likelihood ratio of 7. 35 Different AUC value was possibly due to significant difference in sample size and different characteristics of research sample. The sample size for this research is 77 patients, while the sample size for research conducted by Cettomai, et.…”

Neurology and the Global HIV Epidemic

“…56,73 A limitation of many of these studies is that only few regions have access to advanced diagnostics such as such as nerve conduction studies 74 and epidermal nerve fiber densities, 75 and thus most assessments are based on neuropathy screening tools. [76][77][78] Translational research in resource-limited settings is also on the rise in regions such as South Africa and Thailand. Although studies of the systemic immunologic response to ART have not demonstrated clade differences when the treatment setting is comparable, 6 similar studies of the potential effects of clade differences on HAND prevalence have not been conclusive.…”

Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings

“…Neuropathy and neuropathic pain screening tools provide a possible solution. They provide an abbreviated, focused assessment that can be applied and interpreted quickly by non-experts after no or limited training[ 33 ]. Only two instruments, the Single-Question Neuropathy Screen (SQNS)[ 34 ], and the Brief Peripheral Neuropathy Screen (BPNS)[ 35 ], have been developed specifically for the assessment of HIV-SN.…”