Epidermal nerve fiber density, axonal swellings and QST as predictors of HIV distal sensory neuropathy.
We investigated the associations of baseline epidermal nerve fiber (ENF) densities and morphology (percent ENF swellings) and quantitative sensory testing (QST) with clinically defined human immunodeficiency virus (HIV)-associated distal polyneuropathy (DSP) and whether these measures are predictive of development of symptomatic DSP over time. Fifty-seven HIV-infected subjects with and without DSP and 19 controls participated. Mean ENF densities were lower at the distal leg and proximal thigh in asymptomatic or symptomatic DSP than in controls. Mean ENF densities did not differ significantly among the HIV groups. Percent ENF swellings was higher in patients with symptomatic DSP than controls at the distal leg, and was also greater at the proximal thigh in patients with asymptomatic or symptomatic DSP than in controls. The percent ENF swellings at the distal leg correlated with the thresholds for both minimal (HP 0.5) and intermediate (HP 5.0) heat pain (HP) intensity. A higher percent ENF swellings in the distal leg [hazard ratio (HR) 1.16, 95% CI 1.02-1.31] and HP 0.5 thresholds (HR 1.03, 95% CI 1.01-1.05) were the only two measures associated with a shorter time to development of symptomatic DSP. Quantitation of ENF swellings and heat pain thresholds deserve further study as predictors of symptomatic neuropathy.
Department of Neurology, University of Rochester, SMH 601 Elmwood Avenue, Box 673, Rochester, New York 14642, USA. David_Hermann@urmc.rochester.edu
David N
DN
Herrmann
Michael P
MP
McDermott
Don
D
Henderson
Lin
L
Chen
Kwame
K
Akowuah
Giovanni
G
Schifitto
D000328:Adult; D001369:Axons / Q000473:pathology* / Q000821:virology; D001706:Biopsy; D004817:Epidermis / Q000294:innervation* / Q000473:pathology / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D009410:Nerve Degeneration / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D009431:Neural Conduction / Q000502:physiology; D009475:Neurons, Afferent / Q000473:pathology / Q000821:virology; D011115:Polyneuropathies / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D011237:Predictive Value of Tests; D012016:Reference Values; D011984:Sensory Receptor Cells / Q000473:pathology* / Q000821:virology