title: Utility of quantitative sensory testing and screening tools in identifying HIV-associated peripheral neuropathy in Western Kenya: pilot testing.
abstract: OBJECTIVE
  Neuropathy is the most common neurologic complication of HIV but is widely under-diagnosed in resource-constrained settings. We aimed to identify tools that accurately distinguish individuals with moderate/severe peripheral neuropathy and can be administered by non-physician healthcare workers (HCW) in resource-constrained settings.
  
  
  METHODS
  We enrolled a convenience sample of 30 HIV-infected outpatients from a Kenyan HIV-care clinic. A HCW administered the Neuropathy Severity Score (NSS), Single Question Neuropathy Screen (Single-QNS), Subjective Peripheral Neuropathy Screen (Subjective-PNS), and Brief Peripheral Neuropathy Screen (Brief-PNS). Monofilament, graduated tuning fork, and two-point discrimination examinations were performed. Tools were validated against a neurologist's clinical assessment of moderate/severe neuropathy.
  
  
  RESULTS
  The sample was 57% male, mean age 38.6 years, and mean CD4 count 324 cells/µL. Neurologist's assessment identified 20% (6/30) with moderate/severe neuropathy. Diagnostic utilities for moderate/severe neuropathy were: Single-QNS--83% sensitivity, 71% specificity; Subjective-PNS-total--83% sensitivity, 83% specificity; Subjective-PNS-max and NSS--67% sensitivity, 92% specificity; Brief-PNS--0% sensitivity, 92% specificity; monofilament--100% sensitivity, 88% specificity; graduated tuning fork--83% sensitivity, 88% specificity; two-point discrimination--75% sensitivity, 58% specificity.
  
  
  CONCLUSIONS
  Pilot testing suggests Single-QNS, Subjective-PNS, and monofilament examination accurately identify HIV-infected patients with moderate/severe neuropathy and may be useful diagnostic tools in resource-constrained settings.
authors.affiliation: Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Deanna
authors.initials: D
authors.lastname: Cettomai
authors.forename: Judith
authors.initials: J
authors.lastname: Kwasa
authors.forename: Caroline
authors.initials: C
authors.lastname: Kendi
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
authors.forename: Richard W
authors.initials: RW
authors.lastname: Price
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Ana-Claire
authors.initials: AC
authors.lastname: Meyer
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000821:virology; D003153:Community Health Services; D005260:Female; D015658:HIV Infections / Q000150:complications; D006282:Health Personnel; D006801:Humans; D007630:Kenya; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000821:virology*; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index