Evaluation of a clinical screening tool for HIV-associated sensory neuropathies.
OBJECTIVE
To evaluate the performance characteristics of a brief clinical neuropathy screening tool for use in sensory neuropathies complicating HIV infection.


METHODS
The authors assessed 80 patients using the Brief Peripheral Neuropathy Screen (BPNS). Patients were defined as having neuropathy if they had both symptoms and signs consistent with this diagnosis. All subjects underwent sensory threshold testing and lower limb epidermal nerve fiber quantification using punch skin biopsy as objective measures.


RESULTS
Individuals defined as having neuropathy using the BPNS (n = 37) performed less well on sensory threshold testing than other HIV-infected individuals (p < 0.0001 for warming, cooling, and vibration) and also had lower distal calf epidermal nerve fiber densities (p < 0.0001). Individuals who had symptoms but no neuropathic signs (n = 13) did not perform differently on any objective testing compared with neuropathy-free individuals, supporting the decision to require signs as well as symptoms as an operational criterion for the diagnosis of neuropathy. Of the symptoms listed in the screening tool, the presence of numbness had the greatest diagnostic efficiency for identifying those with neuropathy.


CONCLUSIONS
The Brief Neuropathy Screening Tool (and the chosen definition of neuropathy) accurately detects those HIV-infected individuals with the greatest degree of peripheral nerve dysfunction and pathology. This is a valid neuropathy screening tool for use in the context of HIV infection, and is simple enough to be applicable in resource-limited settings.
Cherry
Catherine L
CL
Burnet Institute, Melbourne, Australia. kate.cherry@med.monash.edu.au
Wesselingh
Steven L
SL
Lal
Luxshimi
L
McArthur
Justin C
JC
D000328:Adult; D000368:Aged; D001706:Biopsy; D003943:Diagnostic Techniques, Neurological; D004568:Electrodiagnosis / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010525:Peripheral Nerves / Q000473:pathology / Q000503:physiopathology*; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011984:Sensory Receptor Cells / Q000473:pathology / Q000503:physiopathology; D012684:Sensory Thresholds; D012867:Skin / Q000294:innervation / Q000473:pathology; D020886:Somatosensory Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014855:Wallerian Degeneration / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology