title: Screening for HIV-associated peripheral neuropathy in resource-limited settings.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, University of California San Francisco, 1001 Potrero Avenue, 4M62, Box 0870, San Francisco, California, 94110, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Cettomai
authors.forename: Judith K
authors.initials: JK
authors.lastname: Kwasa
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
authors.forename: Richard W
authors.initials: RW
authors.lastname: Price
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Caroline
authors.initials: C
authors.lastname: Kendi
authors.forename: Ana-Claire L
authors.initials: AC
authors.lastname: Meyer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006282:Health Personnel / Q000592:standards; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation* / Q000592:standards; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011897:Random Allocation; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; developing countries; peripheral nervous system diseases; screening tools; sensitivity and specificity
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