Abstract
Background/AimNeuropathy 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.MethodsWe 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.ResultsThe 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.ConclusionsPilot 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.
Highlights
Peripheral neuropathy is the most common neurologic complication of HIV but is widely under-recognized and under-treated in resource-constrained settings.[1]
Simple inexpensive diagnostic tools that can be administered by non-physician healthcare workers may improve recognition of neuropathy in resource-constrained settings
We evaluated the utility of the Neuropathy Severity Score (NSS), quantitative sensory testing (QST), and other previously validated diagnostic tools in identifying patients with moderate to severe peripheral neuropathy in a resourceconstrained setting
Summary
Peripheral neuropathy is the most common neurologic complication of HIV but is widely under-recognized and under-treated in resource-constrained settings.[1]. Several screening tools and quantitative sensory testing (QST) methods, including the monofilament, Rydel-Seiffer graduated tuning fork, and two-point discriminator, have been shown to accurately identify individuals with neuropathy.[3,4,5,6,7,8] these tools have been almost exclusively validated in high-income countries by specialized physicians. None includes a functional status assessment which may be important to identify individuals with a moderate to severe neuropathy in need of intervention. We developed the Neuropathy Severity Score (NSS), a novel diagnostic tool with a functional status assessment. We evaluated the utility of the NSS, QST, and other previously validated diagnostic tools in identifying patients with moderate to severe peripheral neuropathy in a resourceconstrained setting
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