Screening for HIV-associated peripheral neuropathy in resource-limited settings

Deanna Cettomai, Judith K. Kwasa, Gretchen L. Birbeck, Richard W. Price, Craig R. Cohen, Elizabeth A. Bukusi, Caroline Kendi, Ana Claire L. Meyer

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: 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.

Original languageEnglish (US)
Pages (from-to)516-524
Number of pages9
JournalMuscle and Nerve
Volume48
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

Keywords

  • Developing countries
  • HIV
  • Peripheral nervous system diseases
  • Screening tools
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)

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