DIAGNOSTIC TEST OF POLYNEUROPATHY SCORE, 10-G SEMMES WENSTEIN MONOFILAMENT (SWM) AND VIBRATION PERCEPTION TRESHOLD (VPT)-QUANTITATIVE SENSORY TESTING (QST) IN DISTAL SENSORY POLYNEUROPATHY (DSP)-HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Abstract

Background: HIV/AIDS is a worldwide pandemic. Peripheral neuropathy is the most common neurologic complication with distal sensory polyneuropathy (HIV-DSP) as the most frequent form of manifestation. HIV-DSP is one of the major causes of global pain morbidity and often undiagnosed earlier, resulting in treatment given when HIV-DSP grade is already severe. Early detection is imperative to prevent the progression of HIV-DSP and improve patient’s quality of life. Polyneuropathy score, 10-g Semmes-Weinstein Monofilament (SWM) and vibration perception threshold (VPT)-quantitative sensory testing (QST) are considered to be potential candidates for HIVDSP screening tool. Objective: To measure the reability of Polyneuropathy Score, SWM and VPT- QST in diagnosing HIV-DSP. Methods: This research is a descriptive study with cross-sectional design. Research was conducted on 77 patients of HIV/AIDS outpatient clinic in RS Saiful Anwar (RSSA) during November 2016 - April 2017 (n = 77). Patients were screened for HIV-DSP by using polyneuropathy score, such as: Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Scoring Sysytem (TCSS), Brief Peripheral Neuropathy Score (BPNS), SWM, and VPT-QST. Sensitivity, specificity, positive predictive value and negative predictive value of BPNS, TCSS, MNSI, SWM and VPT-QST are analyzed using cross tabulation. Area under receiver operating characteristic (ROC) curve analysis was used to measure diagnostic accuracy of each tools. SPSS 19.0 was used for statistical analysis. Results: TCSS had a sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio, negative likelihood ratio, and accuracy as much as: 70%, 97%, 97%, 74%, 23,33, 0,28 and 83%. The result of TCSS analysis using ROC showed that TCSS had excellent diagnostic value with AUC (Area Under Curve) of 0.89 (95%CI 82%-96,5%). The AUC of BPNS score, monofilamen and VPT-QST respectively: 0,469, 0,194, and 0,189. Conclusion: The result of the HIV-DSP diagnostic test using TCSS score has the best value compared to other tools.