Screening for HIV-associated peripheral neuropathy in resource-limited settings
Sources of Support and Conflicts of Interest: This study was supported by the Fulbright African Regional Research Program (Meyer), American Academy of Neurology Practice Research Training Fellowship (Meyer), Doris Duke International Clinical Research Fellowship (Cettomai), and American Medical Association Foundation Seed Grant (Cettomai). In addition, this study was supported by the Fogarty International Clinical Research Fellowship (Meyer, Kwasa) (5 R24 TW00798; 3 R24 TW00798-02S1) from the National Institutes of Health, Fogarty International Center through Vanderbilt University, the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), Office of the Director, National Institutes of Health and the National Institute of Mental Health (NIMH). Dr. Deanna Cettomai has received research support from the Doris Duke Charitable Foundation and an NIH/Johns Hopkins Pre-Doctoral Clinical Research Training Program T32 grant. Dr. Judith Kwasa has received research support from the NIH Fogarty International Clinical Research Scholarship. Dr. Gretchen Birbeck has received NIH research support, including travel and meeting attendance related to R01, R21 and K23 awards, as well as research support from the Doris Duke Charitable Fund. Dr. Richard Price has received support from NIH/NIMH research grants, an investigator-initiated research grant from Merck and a lecture honorarium from Abbott. Dr. Craig Cohen has received funds from Osel, Inc. to conduct a Phase 2a clinical trial of LACTIN-V, a vaginal probiotic to prevent recurrent bacterial vaginosis. Ms. Caroline Kendi has nothing to disclose. Dr. Elizabeth Bukusi has received funding from NIH, CDC, the Bill and Melinda Gates Foundation, and the International Partnership for Microbicides. Dr. Ana-Claire Meyer has received research support from the Fulbright African Regional Research Program, NIH Fogarty International Clinical Research Fellowship (5 R24 TW00798; 3 R24 TW00798-02S1). She is currently the recipient of a K01 and R21 from NIH.
This work was funded by the NIH but is not a US government work, nor is it public domain. It does need to be made available under the public access laws.
Peripheral neuropathy is the most common neurological complication of human immunodeficiency virus (HIV) infection but is widely under-diagnosed in resource-limited settings. We investigated the utility of screening tools administered by nonphysician healthcare workers (HCW) and quantitative sensory testing (QST) administered by trained individuals for identification of moderate/severe neuropathy.
We enrolled 240 HIV-infected outpatients using 2-stage cluster randomized sampling. HCWs administered the several screening tools. Trained study staff performed QST. Tools were validated against a clinical diagnosis of neuropathy.
Participants were 65% women, mean age 36.4 years, median CD4 324 cells/μL. A total of 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.
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. Muscle Nerve 48: 516–524, 2013