title: Correlates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy.
abstract: OBJECTIVE
  To demonstrate the relationship between epidermal nerve fiber density (ENFD) in the leg and the phenotype of HIV-associated distal sensory polyneuropathy (HIV-DSP) in a multicenter prospective study (ACTG A5117).
  
  
  METHODS
  A total of 101 HIV-infected adults, with CD4 cell count <300 cells/mm(3) and who had received antiretroviral therapy (ART) for at least 15 consecutive weeks, underwent standardized clinical and electrophysiologic assessment. All 101 subjects were biopsied at the distal leg (DL) and 99 at the proximal thigh (PT) at baseline. ENFD was assessed by skin biopsy using PGP9.5 immunostaining. Associations of ENFD with demographics, ART treatment, Total Neuropathy Score (TNS), sural sensory nerve action potential (SNAP) amplitude and conduction velocity, quantitative sensory testing (QST) measures, and neuropathic pain were explored.
  
  
  RESULTS
  ENFD at the DL site correlated with neuropathy severity as gauged by TNS (p < 0.01), the level of neuropathic pain quantified by the Gracely Pain Scale (GPS) (p = 0.01) and Visual Analogue Scale (VAS) (p = 0.01), sural SNAP amplitude (p < 0.01), and toe cooling (p < 0.01) and vibration (p = 0.02) detection thresholds. ENFD did not correlate with neurotoxic ART exposure, CD4 cell count, or plasma HIV-1 viral load.
  
  
  CONCLUSIONS
  In subjects with advanced HIV-1 infection, epidermal nerve fiber density (ENFD) assessment correlates with the clinical and electrophysiologic severity of distal sensory polyneuropathy (DSP). ENFD did not correlate with previously established risk factors for HIV-DSP, including CD4 cell count, plasma HIV-1 viral load, and neurotoxic antiretroviral therapy exposure.
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, MD 21287-7609, USA.
authors.forename: L
authors.initials: L
authors.lastname: Zhou
authors.forename: D W
authors.initials: DW
authors.lastname: Kitch
authors.forename: S R
authors.initials: SR
authors.lastname: Evans
authors.forename: P
authors.initials: P
authors.lastname: Hauer
authors.forename: S
authors.initials: S
authors.lastname: Raman
authors.forename: G J
authors.initials: GJ
authors.lastname: Ebenezer
authors.forename: M
authors.initials: M
authors.lastname: Gerschenson
authors.forename: C M
authors.initials: CM
authors.lastname: Marra
authors.forename: V
authors.initials: V
authors.lastname: Valcour
authors.forename: R
authors.initials: R
authors.lastname: Diaz-Arrastia
authors.forename: K
authors.initials: K
authors.lastname: Goodkin
authors.forename: L
authors.initials: L
authors.lastname: Millar
authors.forename: S
authors.initials: S
authors.lastname: Shriver
authors.forename: D M
authors.initials: DM
authors.lastname: Asmuth
authors.forename: D B
authors.initials: DB
authors.lastname: Clifford
authors.forename: D M
authors.initials: DM
authors.lastname: Simpson
authors.forename: J C
authors.initials: JC
authors.lastname: McArthur
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology* / Q000821:virology; D009431:Neural Conduction / Q000502:physiology; D009437:Neuralgia / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D010523:Peripheral Nervous System Diseases / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D010641:Phenotype; D011446:Prospective Studies; D011984:Sensory Receptor Cells / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D012867:Skin / Q000294:innervation / Q000473:pathology / Q000503:physiopathology; D013497:Sural Nerve / Q000473:pathology / Q000503:physiopathology / Q000821:virology