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Zirpoli GR, Farhad K, Klein MC, Downs S, Klein MM, Oaklander AL. Initial validation of the Mass. General Neuropathy Exam Tool (MAGNET) for evaluation of distal small-fiber neuropathy. Muscle Nerve 2024; 69:185-198. [PMID: 38112169 PMCID: PMC10842781 DOI: 10.1002/mus.28013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION/AIMS Diagnosis of small-fiber neuropathy (SFN) is hampered by its subjective symptoms and signs. Confirmatory testing is insufficiently available and expensive, so predictive examinations have value. However, few support the 2020 SFN consensus-case-definition requirements or were validated for non-diabetes neuropathies. Thus we developed the Massachusetts General Hospital Neuropathy Exam Tool (MAGNET) and measured diagnostic performance in 160 symptomatic patients evaluated for length-dependent SFN from any cause and 37 healthy volunteers. METHODS We compared prevalences of abnormalities (vital signs, pupil responses, lower-limb appearance, pin, light touch, vibration and position sensitivity, great-toe strength, muscle stretch reflexes), and validated diagnostic performance against objective SFN tests: lower-leg skin-biopsy epidermal neurite densities and autonomic function testing (AFT). Sensitivity/specificity, feasibility, test-retest and inter-rater reliability, and convergence with the Utah Early Neuropathy Scale were calculated. RESULTS Patients' ages averaged 48.5 ± 14.7 years and 70.6% were female. Causes of neuropathy varied, remaining unknown in 59.5%. Among the 46 with abnormal skin biopsies, the most prevalent abnormality was reduced pin sharpness at the toes (71.7%). Inter-rater reliability, test-retest reliability, and convergent validity excelled (range = 91.3-95.6%). Receiver operating characteristics comparing all symptomatic patients versus healthy controls indicated that a MAGNET threshold score of 14 maximized predictive accuracy for skin biopsies (0.74) and a 30 cut-off maximized accuracy for predicting AFT (0.60). Analyzing patients with any abnormal neuropathy-test results identified areas-under-the-curves of 0.87-0.89 for predicting a diagnostic result, accuracy = 0.80-0.89, and Youden's index = 0.62. Overall, MAGNET was 80%-85% accurate for stratifying patients with abnormal versus normal neuropathy test results. DISCUSSION MAGNET quickly generates research-quality metrics during clinical examinations.
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Affiliation(s)
- Gary R. Zirpoli
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Khosro Farhad
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Madeleine C. Klein
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sean Downs
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Max M. Klein
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA, USA
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Kemp HI, Vollert J, Davies NWS, Moyle GJ, Rice ASC. A Comparison of Self-reported Pain Measures Between Sensory Phenotypes in HIV-associated Sensory Neuropathy. THE JOURNAL OF PAIN 2023; 24:112-127. [PMID: 36116766 DOI: 10.1016/j.jpain.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Painful HIV-associated neuropathy (HIV-SN) is a prevalent co-morbidity of HIV infection. Sensory phenotyping, using quantitative sensory testing (QST) could allow for improved stratification to guide personalized treatment. However, previous methods of QST interpretation have demonstrated limited association with self-reported pain measures. This study sought to identify differences in self-reported pain measures between composite QST-derived sensory phenotypes, and to examine any differences in participants reporting multi-site, multi-etiology chronic pain. In this cross-sectional observational study of participants with HIV (n = 133), individuals were allocated to neuropathy and neuropathic pain groups through clinical assessment and nerve conduction testing. They completed symptom-based questionnaires and underwent standardized QST. Participants were assigned, by pre-determined algorithm, to a QST-derived sensory phenotype. Symptoms were compared between sensory phenotypes. Symptom characteristics and Neuropathic Pain Symptom Inventory scores differed between QST-derived sensory phenotypes: 'sensory loss' was associated with more paroxysmal and paraesthetic symptoms compared to 'thermal hyperalgesia' and 'healthy' phenotypes (P = .023-0.001). Those with painful HIV-SN and additional chronic pain diagnoses were more frequently allocated to the 'mechanical hyperalgesia' phenotype compared to those with painful HIV-SN alone (P = .006). This study describes heterogeneous sensory phenotypes in people living with HIV. Differences in self-reported pain outcomes between sensory phenotypes has the potential to guide future stratified trials and eventually more targeted therapy. PERSPECTIVE: This article presents quantitative sensory testing derived phenotypes, thought to reflect differing pathophysiological pain mechanisms and relates them to self-reported pain measures in people with HIV infection. This could help clinicians stratify patients to individualize analgesic interventions more effectively.
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Affiliation(s)
- Harriet I Kemp
- Pain Research Group, Imperial College London, London, UK.
| | - Jan Vollert
- Pain Research Group, Imperial College London, London, UK; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany; Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Nicholas W S Davies
- Department of Neurology, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Graeme J Moyle
- Department of HIV Medicine, Chelsea & Westminster NHS Foundation Trust, London, UK
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3
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Motwani L, Asif N, Patel A, Vedantam D, Poman DS. Neuropathy in Human Immunodeficiency Virus: A Review of the Underlying Pathogenesis and Treatment. Cureus 2022; 14:e25905. [PMID: 35844323 PMCID: PMC9278792 DOI: 10.7759/cureus.25905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/05/2022] Open
Abstract
This article explores the various causes of the human immunodeficiency virus (HIV), and its associated neuropathy, including the effects of HIV on the nervous system and the long-standing therapy that is often provided to patients with HIV. Several studies regarding the neurotoxic effects of combined antiretroviral therapy (cART) and HIV were reviewed and various hypotheses were discussed. Furthermore, we present the nature of HIV-sensory neuropathy (HIV-SN) among different demographic populations and their subsequent risk factors predisposing them to this condition. It was observed that the incidence of the disease increases in increased survival of the patients as well as in males. Finally, the current approach to HIV-SN and its overlapping features with other causes of peripheral neuropathy have been discussed which demonstrates that a clinical examination is the most important clue for a healthcare professional to suspect the disease. Our main aim was to study the current perspectives and guidelines for diagnosing and managing a patient with HIV-SN to reduce disease prevalence and bring about a more aware frame of mind when following up with an HIV patient.
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Sainsbury B, Bloxham J, Pour MH, Padilla M, Enciso R. Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: a systematic review with meta-analysis. J Dent Anesth Pain Med 2021; 21:479-506. [PMID: 34909469 PMCID: PMC8637910 DOI: 10.17245/jdapm.2021.21.6.479] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/25/2022] Open
Abstract
Background Chronic neuropathic pain (NP) presents therapeutic challenges. Interest in the use of cannabis-based medications has outpaced the knowledge of its efficacy and safety in treating NP. The objective of this review was to evaluate the effectiveness of cannabis-based medications in individuals with chronic NP. Methods Randomized placebo-controlled trials using tetrahydrocannabinol (THC), cannabidiol (CBD), cannabidivarin (CBDV), or synthetic cannabinoids for NP treatment were included. The MEDLINE, Cochrane Library, EMBASE, and Web of Science databases were examined. The primary outcome was the NP intensity. The risk of bias analysis was based on the Cochrane handbook. Results The search of databases up to 2/1/2021 yielded 379 records with 17 RCTs included (861 patients with NP). Meta-analysis showed that there was a significant reduction in pain intensity for THC/CBD by -6.624 units (P < .001), THC by -8.681 units (P < .001), and dronabinol by -6.0 units (P = .008) compared to placebo on a 0-100 scale. CBD, CBDV, and CT-3 showed no significant differences. Patients taking THC/CBD were 1.756 times more likely to achieve a 30% reduction in pain (P = .008) and 1.422 times more likely to achieve a 50% reduction (P = .37) than placebo. Patients receiving THC had a 21% higher improvement in pain intensity (P = .005) and were 1.855 times more likely to achieve a 30% reduction in pain than placebo (P < .001). Conclusion Although THC and THC/CBD interventions provided a significant improvement in pain intensity and were more likely to provide a 30% reduction in pain, the evidence was of moderate-to-low quality. Further research is needed for CBD, dronabinol, CT-3, and CBDV.
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Affiliation(s)
- Bradley Sainsbury
- Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Jared Bloxham
- Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Masoumeh Hassan Pour
- Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Mariela Padilla
- Clinical Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Reyes Enciso
- Department of Geriatrics, Special Patients and Behavioral Science, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California, USA
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Abstract
Painful distal symmetrical polyneuropathy is common in HIV and is associated with reduced quality of life. Research has not explored the experience of neuropathic pain in people with HIV from a person-centred perspective. Therefore, a qualitative interview study was conducted to more deeply understand the experience and impact of neuropathic pain in this population. Semistructured interviews were conducted with 26 people with HIV and peripheral neuropathic pain symptoms. Interviews explored the impact of pain and participants' pain management strategies. Interviews were transcribed verbatim and analysed using thematic analysis. Four themes and 11 subthemes were identified. Theme 1 reflects the complex characterisation of neuropathic pain, including the perceived unusual nature of this pain and diagnostic uncertainty. Theme 2 centred on the interconnected impacts of pain on mood and functioning and includes how pain disrupts relationships and threatens social inclusion. Theme 3 reflects the struggle for pain relief, including participants' attempts to "exhaust all options" and limited success in finding lasting relief. The final theme describes how pain management is complicated by living with HIV; this theme includes the influence of HIV stigma on pain communication and pain as an unwanted reminder of HIV. These data support the relevance of investigating and targeting psychosocial factors to manage neuropathic pain in HIV.
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Scott W, Guildford BJ, Badenoch J, Driscoll E, Chilcot J, Norton S, Kemp HI, Lee MJ, Lwanga J, Boffito M, Moyle G, Post FA, Campbell L, Josh J, Clift P, C de C Williams A, Rice AS, McCracken LM. Feasibility randomized-controlled trial of online acceptance and commitment therapy for painful peripheral neuropathy in people living with HIV: The OPEN study. Eur J Pain 2021; 25:1493-1507. [PMID: 33711209 DOI: 10.1002/ejp.1762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/06/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Neuropathic pain negatively affects quality of life among people living with HIV (PLWH). This study examined the feasibility of conducting a full-scale randomized-controlled trial of online acceptance and commitment therapy ("ACT OPEN") for neuropathic pain in PLWH. METHODS Using a parallel-groups design, thirty-eight participants were randomized to ACT OPEN or a waitlist control (2:1). Participants completed standard self-report outcome measures at baseline, and two- and five-months post-randomization. Participants were aware of their allocation, but assessment was blinded. RESULTS Twenty-five participants were randomized to ACT OPEN and 13 to the control (of 133 referrals). ACT OPEN completion was 69% and two-month trial retention was 82%. Treatment credibility and satisfaction scores for ACT OPEN were comparable to scores reported in previous trials of cognitive-behavioural treatments for pain. Four adverse events were reported during the study, including one serious adverse event; all of these were unrelated to the research procedures. Small to moderate effects and 95% confidence intervals suggest that the true effect may favour ACT OPEN for improvements in pain intensity/interference and depression. CONCLUSIONS A full-scale RCT of online ACT for pain management in PLWH may be feasible with refinements to trial design to facilitate recruitment. SIGNIFICANCE Research on pain management in people living with HIV has primarily focused on pharmacological treatments with limited success. This is the first study to show the potential feasibility of a psychological treatment based on acceptance and commitment therapy delivered online and tailored for pain management in people with HIV ("ACT OPEN"). ACT OPEN may be a promising treatment in this population and further evaluation in a full-scale randomized-controlled trial appears warranted. TRIAL REGISTRATION The trial was registered (clinicaltrials.gov; NCT03584412).
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,INPUT Pain Management Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Beth J Guildford
- Dental Psychology Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Badenoch
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Elizabeth Driscoll
- INPUT Pain Management Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Harriet I Kemp
- Pain Research Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Ming J Lee
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julianne Lwanga
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Graeme Moyle
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Frank A Post
- Caldecot Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Lucy Campbell
- Caldecot Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Jo Josh
- UK Community Advisory Board, London, UK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Andrew Sc Rice
- Pain Research Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
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Kemp HI, Kennedy DL, Vollert J, Davies NWS, Scott W, Rice ASC. Chronic pain and cognitive impairment: a cross-sectional study in people living with HIV. AIDS Care 2021:1-14. [PMID: 33739206 DOI: 10.1080/09540121.2021.1902934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cognitive impairment and chronic pain are amongst the most prevalent neurological sequelae of HIV infection, yet little is understood about the potential bidirectional relationship between the two conditions. Cognitive dysfunction can occur in chronic pain populations whilst those with cognitive impairment can display modified responses to experimentally induced painful stimuli. To date, this has not been explored in HIV cohorts.This study aimed to identify any contribution of chronic pain to cognitive impairment in HIV and to determine differences in pain characteristics between those with and without cognitive dysfunction.This was an observational cohort study involving people living with HIV (n = 148) in the United Kingdom. Participants underwent validated questionnaire-based measurement of pain severity, interference and symptom quality as well as conditioned pain modulation and quantitative sensory testing. All participants completed a computer-based cognitive function assessment.Fifty-seven participants met the criteria for cognitive impairment and 73 for chronic pain. The cognitive impairment group had a higher prevalence of chronic pain (p = 0.004) and reported more neuropathic symptoms (p = 0.001). Those with chronic pain performed less well in emotional recognition and verbal learning domains. The interaction identified between chronic pain and cognitive dysfunction warrants further exploration to identify causal links or shared pathology.
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Affiliation(s)
- Harriet I Kemp
- Pain Research Group, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Donna L Kennedy
- Pain Research Group, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Jan Vollert
- Pain Research Group, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Nicholas W S Davies
- Department of Neurology, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew S C Rice
- Pain Research Group, Department of Surgery & Cancer, Imperial College London, London, UK
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Sipilä R, Kemp H, Harno H, Rice ASC, Kalso E. Health-related quality of life and pain interference in two patient cohorts with neuropathic pain: breast cancer survivors and HIV patients. Scand J Pain 2021; 21:512-521. [PMID: 33725747 DOI: 10.1515/sjpain-2020-0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Persistent pain is common in HIV patients and breast cancer (BC) survivors. The aim of this study was to compare two patient groups with neuropathic pain (NP) regarding several psychological variables and Health-related Quality of Life. Although, treatment of pain is always planned individually, the knowledge of the differences and similarities between the patient groups may help us to understand more precisely the targets of the interventions for pain. METHODS Eighty nine BC and 73 HIV patients with symptoms of neuropathic pain (patients with ≥3/7 in the Douleur Neuropathique four interview part (DN4i)) participated in a cross-sectional study. Patients completed questionnaires about mood (HADS), symptoms of insomnia (ISI), pain catastrophizing (PCS), personality (TIPI), Mental and Physical Health-related Quality of Life (M/PHrQoL, RAND/SF-36), and pain intensity and interference (BPI). Analyses were applied by using t-tests and linear regression to assess associations between the studied factors. RESULTS HIV patients reported higher anxiety (p<0.001), depressive symptoms (p<0.001), pain catastrophizing (p<0.001) and pain interference (p<0.001), poorer sleep (p<0.001), and lower HrQoL in all dimensions compared with BC survivors. There were significant differences in personality traits extraversion, emotional stability, and agreeableness between the two patient groups. In HIV patients, pain interference (β=-0.344, p<0.001) and mood (β=-0.580, p<0.001) and in the BC group, mood (β=-0.591, p<0.001), extraversion (β=0.229, p=0.005) and sleep (β=-0.154, p=0.042) associated with MHrQoL. Pain interference (HIV β=-0.645, p<0.001, BC β=-0.491, p<0.001) and age (HIV β=-0.016, p=0.042 and BC β=-0.018, p=0.019) associated with PHrQoL in both groups, and catastrophizing in the BC group (β=-0.303, p<0.001). CONCLUSIONS HIV patients and BC survivors with neuropathic pain, measured with DN4i, have significant differences in various health-related variables and Health-related Quality of Life with both patient groups reporting low HrQoL. The differences in low HrQoL may reflect the fundamental differences between these diseases, BC survivors in remission and HIV patients living with a chronic disease that is under control. This study brings information about the diversity of different patient populations with symptoms of neuropathic pain, and how neuropathic pain associates with wide range of health-related factors. Interventions to support better coping with the symptoms of neuropathic pain could be tailored more individually if the background disease is taken into account.
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Affiliation(s)
- Reetta Sipilä
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,SleepWell Research Programme, University of Helsinki, Helsinki, Finland
| | - Harriet Kemp
- Pain Research Group, Imperial College London, London, UK
| | - Hanna Harno
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,SleepWell Research Programme, University of Helsinki, Helsinki, Finland.,Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Eija Kalso
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,SleepWell Research Programme, University of Helsinki, Helsinki, Finland.,Department of Pharmacology, University of Helsinki, Helsinki, Finland
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9
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Scott W, Badenoch J, Garcia Calderon Mendoza Del Solar M, Brown DA, Kemp H, McCracken LM, C de C Williams A, Rice ASC. Acceptability of psychologically-based pain management and online delivery for people living with HIV and chronic neuropathic pain: a qualitative study. Scand J Pain 2021; 21:296-307. [PMID: 33544549 DOI: 10.1515/sjpain-2020-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chronic neuropathic pain is common in people living with HIV. Psychological treatments can improve quality of life for people with chronic pain in general, and online delivery can increase access to these treatments. However, the acceptability of psychological treatment and online delivery have not been investigated in-depth in people living with HIV and chronic neuropathic pain. Therefore, a qualitative study was undertaken to explore views about a psychological treatment for pain management in this population and to investigate the acceptability of online treatment delivery. METHODS Qualitative interviews were conducted and analysed using inductive thematic analysis, adopting a critical realist perspective. Twenty-six people living with HIV and chronic neuropathic pain completed semi-structured interviews. Their views about a psychological treatment for pain management and online delivery were explored in-depth. RESULTS Three themes and 12 subthemes were identified. Theme one represents a desire for a broader approach to pain management, including not wanting to take more pills and having multidimensional goals that were not just focussed on pain relief. Theme two includes barriers to online psychologically-based pain management, including concerns about using the Internet and confidentiality. Theme three describes treatment facilitators, including accessibility, therapist support, social connection, and experiencing success. CONCLUSIONS A psychological treatment for chronic neuropathic pain management appears acceptable for people living with HIV. Therapist-supported online delivery of cognitive-behavioural pain management may be acceptable for people living with HIV given appropriate development of the treatment to address identified barriers to engagement. These data can inform developments to enhance engagement in online psychologically-informed pain management in people living with HIV and more broadly in remote delivery of psychological treatments.
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Badenoch
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Harriet Kemp
- Department of Surgery & Cancer, Faculty of Medicine, Pain Research Group, Imperial College London, London, UK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Andrew S C Rice
- Department of Surgery & Cancer, Faculty of Medicine, Pain Research Group, Imperial College London, London, UK
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10
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Kietrys DM, Parrott JS, Galantino ML, Davis T, Levin T, O'Brien KK. Self-Reported Disability in Persons With HIV-Related Neuropathy Is Mediated by Pain Interference and Depression. Phys Ther 2020; 100:2174-2185. [PMID: 32914180 DOI: 10.1093/ptj/pzaa161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability. METHODS In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability. RESULTS Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056). CONCLUSION In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression. IMPACT Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression. LAY SUMMARY People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.
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Affiliation(s)
- David M Kietrys
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, 200 College Dr, Jefferson Hall #308, Blackwood, NJ 08012 (USA)
| | - James Scott Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers, The State University of New Jersey
| | - Mary Lou Galantino
- Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, New Jersey; Family Medicine and Community Health, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania; and University of Witwatersrand, Johannesburg, South Africa
| | - Tracy Davis
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers, The State University of New Jersey
| | - Todd Levin
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey; and Jefferson Health, Voorhees, New Jersey
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto; and Rehabilitation Sciences Institute, University of Toronto
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11
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Mukoma JN, Matheri JM, Tawa N. Prevalence and clinical characteristics associated with peripheral neuropathy amongst persons on HAART in Busia County, Kenya. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1430. [PMID: 32935068 PMCID: PMC7479421 DOI: 10.4102/sajp.v76i1.1430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite improved immunological and viral load control, the prevalence of HIV/AIDS-related peripheral neuropathy among survivors on highly active antiretroviral therapy (HAART) is rising globally raising public health concerns. Objectives To determine the prevalence and clinical characteristics of peripheral neuropathy amongst persons on HAART attending Comprehensive Care Clinics in Busia County, Kenya. Method This cross-sectional descriptive quantitative study utilised purposive sampling and included 289 adults living with HIV/AIDS. Data collection was undertaken using the Clinical HIV Associated Neuropathy Tool (CHANT) and analysed using the Statistical Package for the Social Sciences version 25.0. Results Of people on HAART, 68.17% (197 amongst 289) had peripheral neuropathy. The majority were female 76.8% (n = 222), 38.1% (n = 110) were between 41 and 50, and 35% (n = 101) were widowed. The most common primary symptom was reduced right foot big toe vibration (76.8%, n = 222). There was a strong positive relationship (r = 0.621, P = 0.000) between foot vibration and illness. There was a statistically significant influence of demographic characteristics of persons on HAART on PN as they accounted for 98.5% of the variance (R2 = 0.985). Conclusion Peripheral neuropathy is prevalent and is significantly influenced by socio-demographic characteristics of persons on HAART-PN. Early diagnosis and exercise guidance by physiotherapists is key in forestalling severe symptoms, disability and poor quality of life. Clinical implications There is need to screen persons living with HIV on HAART for PN to establish their medical, physiotherapy and rehabilitation needs. Early diagnosis will encourage healthcare workers to start interventions to prevent progression of impairment, onset of disability and decrease in quality of life. Therefore, adaptation of PN screening tools and physiotherapeutic interventions should be considered.
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Affiliation(s)
- John N Mukoma
- Department of Physiotherapy, Busia County Referral Hospital, Busia, Kenya
| | - Joseph M Matheri
- Department of Physiotherapy, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nassib Tawa
- Department of Physiotherapy, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,The Center for Research in Spinal Health & Rehabilitation Medicine, Nairobi, Kenya
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12
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Eibach L, Scheffel S, Cardebring M, Lettau M, Özgür Celik M, Morguet A, Roehle R, Stein C. Cannabidivarin for HIV-Associated Neuropathic Pain: A Randomized, Blinded, Controlled Clinical Trial. Clin Pharmacol Ther 2020; 109:1055-1062. [PMID: 32770831 DOI: 10.1002/cpt.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/25/2020] [Indexed: 01/02/2023]
Abstract
HIV remains a major burden to the health care system and neuropathic pain is the most common neurological complication of HIV infection. Because current treatment strategies often lack satisfying pain relief, cannabinoids (CBs) are discussed as a new option. We investigated cannabidivarin (CBDV) as treatment for HIV-associated neuropathic pain. We conducted a randomized, double-blind, placebo-controlled crossover study. Patients underwent two successive treatment phases (4 weeks each) and were treated with CBDV (400 mg/day) or placebo in a randomized order. A 3-week washout phase was designed to eliminate potential carry-over effects. Patients were followed up for 3 weeks after the end of the second treatment phase. The primary end point was pain intensity on an 11-point numeric rating scale, recorded in a diary. Secondary end points were additional pain medication, pain characteristics, and quality of life. We included 32 patients. The mean pain intensity under CBDV was 0.62 points higher compared with placebo (P = 0.16, 95% confidence interval -0.27 to 1.51). CBDV did not influence the amount of additional pain medication, pain characteristics, or quality of life. The incidence of adverse events was similar during both treatments. No suspected unexpected adverse reactions occurred during either treatment. CBDV was safe but failed to reduce neuropathic pain in patients with HIV. This may be explained by a lack of CB receptor activation, as indicated by preclinical experiments. Although a larger patient number might be desirable, we would not expect a change in the conclusions because the present differences are far from statistical significance. Therefore, we would currently not consider CBDV as a clinically meaningful treatment option for neuropathic pain.
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Affiliation(s)
- Luca Eibach
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Simone Scheffel
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.,SteriPharm Pharmazeutische Produkte, Berlin, Germany
| | - Madeleine Cardebring
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.,Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Marie Lettau
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - M Özgür Celik
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Morguet
- Department of Cardiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Coordinating Center for Clinical Studies, Berlin Institute of Health, Charité Universitätsmedizin, Berlin, Germany
| | - Christoph Stein
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
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13
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Gaff J, Pillay P, Cherry C, Laws SM, Price P, Kamerman P. The role of CAMKK2 polymorphisms in HIV-associated sensory neuropathy in South Africans. J Neurol Sci 2020; 416:116987. [PMID: 32585444 DOI: 10.1016/j.jns.2020.116987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/30/2022]
Abstract
Human immunodeficiency virus-associated sensory neuropathy (HIV-SN) is a common neurological complication of HIV infection. It affected 57% of South African patients whose antiretroviral therapy (ART) included stavudine and was influenced by genotypes of the P2X-block (P2X7R, P2X4R and CAMKK2). We investigate associations between HIV-SN and P2X-block genotypes in patients who never received stavudine. An adjacent gene, ANAPC5, was included. 75 HIV+ individuals were assessed using the Brief Peripheral Neuropathy Screen before treatment and after 6-8 months on stavudine-free regimens. DNA was genotyped for 48 polymorphisms across the four genes using an OpenArray™ platform. Haplotypes were derived using fastPHASE. Associations with HIV-SN were assessed using bivariate and multivariate analyses. Nine individuals (12%) were diagnosed with HIV-SN prior to ART and a further 20 individuals (27%) developed HIV-SN within 6-8 months. Five polymorphisms, rs503720*G (OR = 133) in P2X7R, rs10849861*A (OR = 5.99), rs1653586*T (OR = 67.8) and rs11065504*C (OR = 0.02) in CAMKK2, and rs2089886*A (OR = 6.68) in ANAPC5, associated with HIV-SN after adjusting for body weight, nadir CD4 T-cell counts and prior tuberculosis (model p < 0.0001, n = 69, Pseudo R2 = 0.54). Three CAMKK2 haplotypes were associated with HIV-SN (OR = 2.82, 3.42 and 6.85) after adjusting for body weight, nadir CD4 T-cell counts and prior tuberculosis (model p < 0.0005, n = 71, Pseudo R2 = 0.26). The results support a role for CAMKK2 in HIV-SN, independent of mechanisms invoked by stavudine. SIGNIFICANCE STATEMENT: HIV-associated sensory neuropathy (HIV-SN) remains a clinically relevant complication of HIV infection and its treatment, affecting 38% of patients treated without neurotoxic stavudine. HIV-SN can impact an individual's ability to work and quality of life, with few effective therapeutic options, so an understanding of the underlying mechanisms would have clinical value. We confirm that CAMKK2 polymorphisms and haplotypes influence susceptibility to HIV-SN in South Africans treated without stavudine. This provides further evidence for a role for the protein encoded by CAMKK2 in the pathogenesis of HIV-SN, independent of mechanisms initiated by stavudine.
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Affiliation(s)
- Jessica Gaff
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
| | - Prinisha Pillay
- Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Catherine Cherry
- Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa; Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia; Burnet Institute, Melbourne, Australia
| | - Simon M Laws
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia; Collaborative Genomics Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Patricia Price
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia; Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa.
| | - Peter Kamerman
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia; Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
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14
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TNF-Block Genotypes Influence Susceptibility to HIV-Associated Sensory Neuropathy in Indonesians and South Africans. Int J Mol Sci 2020; 21:ijms21020380. [PMID: 31936167 PMCID: PMC7014294 DOI: 10.3390/ijms21020380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 11/17/2022] Open
Abstract
HIV-associated sensory neuropathy (HIV-SN) is a disabling complication of HIV disease and antiretroviral therapies (ART). Since stavudine was removed from recommended treatment schedules, the prevalence of HIV-SN has declined and associated risk factors have changed. With stavudine, rs1799964*C (TNF-1031) associated with HIV-SN in Caucasians and Indonesians but not in South Africans. Here, we investigate associations between HIV-SN and rs1799964*C and 12 other polymorphisms spanning TNF and seven neighboring genes (the TNF-block) in Indonesians (n = 202; 34/168 cases) and South Africans (n = 75; 29/75 cases) treated without stavudine. Haplotypes were derived using fastPHASE and haplotype networks built with PopART. There were no associations with rs1799964*C in either population. However, rs9281523*C in intron 10 of BAT1 (alternatively DDX39B) independently associated with HIV-SN in Indonesians after correcting for lower CD4 T-cell counts and >500 copies of HIV RNA/mL (model p = 0.0011, Pseudo R2 = 0.09). rs4947324*T (between NFKBIL1 and LTA) independently associated with reduced risk of HIV-SN and shared haplotype 1 (containing no minor alleles) associated with increased risk of HIV-SN after correcting for greater body weight, a history of tuberculosis and nadir CD4 T-cell counts (model: p = 0.0003, Pseudo R2 = 0.22). These results confirm TNF-block genotypes influence susceptibility of HIV-SN. However, critical genotypes differ between ethnicities and with stavudine use.
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15
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Affiliation(s)
- Tara Renton
- Kings College Hospital‐Oral Surgery University of London London UK
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16
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Pillay P, Wadley AL, Cherry CL, Karstaedt AS, Kamerman PR. Clinical diagnosis of sensory neuropathy in HIV patients treated with tenofovir: A 6-month follow-up study. J Peripher Nerv Syst 2019; 24:304-313. [PMID: 31587421 DOI: 10.1111/jns.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sensory neuropathy (SN) is a common and often painful neurological condition associated with HIV-infection and its treatment. However, data on the incidence of SN in neuropathy-free individuals initiating combination antiretroviral therapies (cART) that do not contain the neurotoxic agent stavudine are lacking. AIMS We investigated the 6-month incidence of SN in ART naïve individuals initiating tenofovir (TDF)-based cART, and the clinical factors associated with the development of SN. METHODS 120 neuropathy-free and ART naïve individuals initiating cART at a single center in Johannesburg, South Africa were enrolled. Participants were screened for SN using clinical signs and symptoms at study enrolment and approximately every 2-months for a period of ~6-months. Diagnostic criteria for symptomatic SN was defined by the presence of at least one symptom (pain/burning, numbness, paraesthesias) and at least two clinical signs (reduced vibration sense, absent ankle reflexes or pin-prick hypoaesthesia). Diagnostic criteria for asymptomatic SN required at least two clinical signs only (as above). RESULTS A total of 88% of the cohort completed three visits within the 6-month period. The 6-month cumulative incidence of neuropathy was 140 cases per 1000 patients (95% CI: 80-210) at an incidence rate of 0.37 (95% CI: 0.2-0.5) per person year. Height and active tuberculosis (TB) disease were independently associated with the risk of developing SN (P < .05). INTERPRETATION We found that within the first 6 months of starting cART, incident SN persists in the post-stavudine era, with 11 (9%) of individuals developing asymptomatic SN, and 9 (8%) developing symptomatic SN.
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Affiliation(s)
- Prinisha Pillay
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine L Cherry
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Alan S Karstaedt
- Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Peter R Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
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17
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Gewandter JS, Gibbons CH, Campagnolo M, Lee J, Chaudari J, Ward N, Burke L, Cavaletti G, Herrmann DN, McArthur JC, Russell JW, Smith AG, Smith SM, Turk DC, Dworkin RH, Freeman R. Clinician-rated measures for distal symmetrical axonal polyneuropathy: ACTTION systematic review. Neurology 2019; 93:346-360. [PMID: 31320471 DOI: 10.1212/wnl.0000000000007974] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Distal symmetrical axonal polyneuropathy (DSP) is due to injury to peripheral sensory, motor, and autonomic nerve fibers, resulting in distal predominant sensory loss, pain, and gait instability. DSP occurs as a complication of multiple medical conditions including diabetes or HIV, or following exposure to various toxins such as chemotherapy. It affects at least 10% of the United States population. Few treatments for DSP are approved by regulatory agencies. Reliable and responsive outcome measures are integral to developing new DSP treatments. Multiple clinician-rated measures that incorporate neuropathy signs exist, however, it is not clear which of these measures performs best for various DSP phenotypes. This systematic review summarizes the content of 18 published measures of DSP identified using PubMed and from personal archives of the authors. The relative percentage of scoring dedicated to motor, reflex, large and small fiber sensory, and autonomic domains varied considerably among measures. The most common neurologic examination items included in the scales were (1) vibration perception (n = 18, 100%), (2) reflexes (n = 16, 89%), (3) pinprick perception (n = 14, 78%), (4) muscle strength (n = 11, 61%), (5) touch-pressure perception (n = 9, 50%), and (6) joint position perception (n = 8, 44%). This review can be used to inform decisions regarding which of the available clinician-rated sign outcome measures would be most appropriate for use in a particular DSP population, based on the domains most affected by that neuropathy or on the domains most likely to be affected by a particular experimental therapy.
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Affiliation(s)
- Jennifer S Gewandter
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle.
| | - Christopher H Gibbons
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle.
| | - Marta Campagnolo
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Joonho Lee
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Jenna Chaudari
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Nam Ward
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Laurie Burke
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Guido Cavaletti
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - David N Herrmann
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Justin C McArthur
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - James W Russell
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - A Gordon Smith
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Shannon M Smith
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Dennis C Turk
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Robert H Dworkin
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
| | - Roy Freeman
- From the University of Rochester (J.S.G., J.L., J.C., N.W., D.N.H., S.M.S., R.H.D.), NY; Harvard Medical School (C.H.G., M.C., R.F.), Boston, MA; LORA Group, LLC (L.B.), Royal Oak, MD; University of Milano-Bicocca (G.C.), Monza, Italy; Johns Hopkins University (J.C.M.); University of Maryland and Veterans Administration Maryland Health Care System (J.W.R.), Baltimore, MD; Virginia Commonwealth University (A.G.S.), Richmond; and University of Washington (D.C.T.), Seattle
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Puplampu P, Ganu V, Kenu E, Kudzi W, Adjei P, Grize L, Käser M. Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana. J Neurovirol 2019; 25:464-474. [PMID: 31028691 PMCID: PMC6746675 DOI: 10.1007/s13365-019-00743-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/01/2019] [Accepted: 03/21/2019] [Indexed: 01/11/2023]
Abstract
Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38-10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26-0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36-1.83 and aOR = 2.17; 95% CI 0.93-5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS' quality of life.
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Affiliation(s)
- Peter Puplampu
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
| | - William Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Michael Käser
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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19
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Abstract
BACKGROUND Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. METHODS Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. RESULTS Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. CONCLUSION Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.
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Affiliation(s)
- William P Howlett
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Center for International Health, University of Bergen, Norway
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Scott W, Arkuter C, Kioskli K, Kemp H, McCracken LM, Rice AS, de C. Williams AC. Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis. Pain 2018; 159:2461-2476. [PMID: 30130299 PMCID: PMC6250281 DOI: 10.1097/j.pain.0000000000001369] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 01/11/2023]
Abstract
Chronic pain remains a prevalent and disabling problem for people living with HIV in the current antiretroviral treatment era. Psychosocial treatments may have promise for managing the impact of this pain. However, research is needed to identify psychosocial processes to target through such treatments. The current systematic review and meta-analysis examined the evidence for psychosocial factors associated with pain, disability, and quality of life in people living with HIV and persistent pain. Observational and experimental studies reporting on the association between one or more psychosocial factors and one or more pain-related variables in an adult sample of people living with HIV and pain were eligible. Two reviewers independently conducted eligibility screening, data extraction, and quality assessment. Forty-six studies were included in the review and 37 of these provided data for meta-analyses (12,493 participants). "Some" or "moderate" evidence supported an association between pain outcomes in people with HIV and the following psychosocial factors: depression, psychological distress, posttraumatic stress, drug abuse, sleep disturbance, reduced antiretroviral adherence, health care use, missed HIV clinic visits, unemployment, and protective psychological factors. Surprisingly, few studies examined protective psychological factors or social processes, such as stigma. There were few high-quality studies. These findings can inform future research and psychosocial treatment development in this area. Greater theoretical and empirical focus is needed to examine the role of protective factors and social processes on pain outcomes in this context. The review protocol was registered with PROSPERO (CRD42016036329).
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Chinar Arkuter
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kitty Kioskli
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Kemp
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lance M. McCracken
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C. de C. Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
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Mawuntu AH, Mahama CN, Khosama H, Estiasari R, Imran D. Early detection of peripheral neuropathy using stimulated skin wrinkling test in human immunodeficiency virus infected patients: A cross-sectional study. Medicine (Baltimore) 2018; 97:e11526. [PMID: 30045275 PMCID: PMC6078746 DOI: 10.1097/md.0000000000011526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Peripheral neuropathy is a common condition of human immunodeficiency virus (HIV)-infected patients, which often remains undetected. We assessed the performance of stimulated skin wrinkling-eutectic mixture of local anesthetic (SSW-EMLA) test compared with brief peripheral neuropathy screening (BPNS) to detect HIV neuropathy.This is a cross-sectional study conducted in HIV-positive patients. A modified skin wrinkling grading was used to assess SSW-EMLA effect. BPNS-detectable neuropathy was assessed by a combination of neuropathy severity scoring scale (subjective) and objective method of sensory and tendon reflex examination. The SSW-EMLA test accuracy with reference to BPNS was assessed using sensitivity and specificity and predictive values.In a total of 99 HIV patients, 61.6% were males and the majority age group were between 30 and 40 years (52%). The neuropathy detection was SSW-EMLA test 36.4% versus BPNS 15.2% (P = .04). The sensitivity of SSW-EMLA test was 60.0% [95% confidence interval (95% CI) 34.5-81.7], specificity 67% (95% CI 63.3-3-71.7), and overall accuracy of 66.7% (95% CI 58.9-73.2).The SSW-EMLA test detected many more peripheral neuropathy cases than BPNS in HIV patients and has potential as an alternative test for screening for HIV neuropathy in resource-constraint hospitals in Indonesia.
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Affiliation(s)
- Arthur H.P. Mawuntu
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Corry N. Mahama
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Herlyani Khosama
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Riwanti Estiasari
- Neurology Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Darma Imran
- Neurology Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Schnall R, Siegel K, Jia H, Olender S, Hirshfield S. Racial and socioeconomic disparities in the symptom reporting of persons living with HIV. AIDS Care 2018; 30:774-783. [PMID: 29353489 PMCID: PMC5911686 DOI: 10.1080/09540121.2017.1417532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Persons living with HIV (PLWH) today can survive decades with the disease, making the symptom experience much more relevant to their lifestyle and health outcomes. The goal of the research reported here was to assess the symptom reporting of PLWH in the Unites States (US) in the combined antiretroviral therapy (cART) age of the epidemic. We conducted an anonymous online survey of symptomatic PLWH in the US and asked participants to report the frequency and intensity of 28 frequently occurring symptoms in the past 30 days. The relationship between symptom reporting and demographic factors was investigated using the adaptive least absolute shrinkage and selection operator (LASSO) method. Fatigue was the most frequently reported symptom in our study population. Those with the lowest income were more likely to report more burdensome symptoms. In comparison to other racial and ethnic groups, Black non-Hispanic participants were significantly more likely to report a lower symptom burden score for fatigue, depression, muscle aches, anxiety, difficulties with memory and concentration. There were no racial/ ethnic differences in the burden of the symptoms related to sleep or neuropathy. Findings from this study present new evidence on the symptom reporting of PLWH in the US. Neuropathy continues to be a pervasive neurological symptom with no difference noted between racial/ ethnic groups.
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Affiliation(s)
| | - Karolynn Siegel
- b Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Haomiao Jia
- c Division of Infectious Diseases, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Susan Olender
- c Division of Infectious Diseases, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Sabina Hirshfield
- d Public Health Solutions, Research and Evaluation Division , New York , NY , USA
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Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies. Pain Rep 2018; 3:e638. [PMID: 29756085 PMCID: PMC5902246 DOI: 10.1097/pr9.0000000000000638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/19/2017] [Accepted: 12/25/2017] [Indexed: 01/16/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic profile and amitriptiline may constitute a candidate drug for future formal clinical trials. Introduction: Previous studies reported a high prevalence of neuropathic pain in leprosy, being especially present in “pharmacologically cured” patients. The presence of neuropathic pain in leprosy poses a supplementary burden in patient's quality of life, daily activities, and mood. Objectives: The aim of this study was to assess whether neuropathic pain in leprosy has similar symptom profile as neuropathic pain of other etiologies and to retrospectively assess the efficacy of neuropathic pain medications regularly prescribed to leprosy. Methods: Leprosy and nonleprosy patients had their neuropathic pain characterized by the neuropathic pain symptom inventory (NPSI, ranges from 0 to 100, with 100 being the maximal neuropathic pain intensity) in a first visit. In a second visit, leprosy patients who had significant pain and received pharmacological treatment in the first evaluation were reassessed (NPSI) and had their pain profile and treatment response further characterized, including information on drugs prescribed for neuropathic pain and their respective pain relief. Results: The pain characteristics based on NPSI did not significantly differ between leprosy and nonleprosy neuropathic pain patients in visit 1 after correction for multiple analyses, and cluster analyses confirmed these findings (ie, no discrimination between leprosy and nonleprosy groups; Pearson χ2 = 0.072, P = 0.788). The assessment of pain relief response and the drugs taken by each patient, linear regression analysis showed that amitriptyline, when effective, had the highest percentage of analgesic relief. Conclusions: Neuropathic pain in leprosy is as heterogeneous as neuropathic pain of other etiologies, further supporting the concept that neuropathic pain is a transetiological entity. Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic profile in general, and amitriptiline may constitute a potential candidate drug for future formal clinical trials aimed at controlling neuropathic pain in leprosy.
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Kemp HI, Petropoulos IN, Rice ASC, Vollert J, Maier C, Strum D, Schargus M, Peto T, Hau S, Chopra R, Malik RA. Use of Corneal Confocal Microscopy to Evaluate Small Nerve Fibers in Patients With Human Immunodeficiency Virus. JAMA Ophthalmol 2017; 135:795-800. [PMID: 28594979 DOI: 10.1001/jamaophthalmol.2017.1703] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Objective quantification of small fiber neuropathy in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy (HIV-SN) is difficult but needed for diagnosis and monitoring. In vivo corneal confocal microscopy (IVCCM) can quantify small fiber damage. Objective To establish whether IVCCM can identify an abnormality in corneal nerve fibers and Langerhans cells in patients with and without HIV-SN. Design, Setting, and Participants This prospective, cross-sectional cohort study was conducted between July 24, 2015, and September 17, 2015. Twenty patients who were HIV positive were recruited from adult outpatient clinics at Chelsea and Westminster Hospital NHS Foundation Trust in England. These patients underwent IVCCM at Moorfields Eye Hospital NHS Foundation Trust in London, England, and the IVCCM images were analyzed at Weill Cornell Medicine-Qatar in Ar-Rayyan, Qatar. Patients were given a structured clinical examination and completed validated symptom questionnaires and the Clinical HIV-Associated Neuropathy Tool. Results from patients with HIV were compared with the results of the age- and sex-matched healthy control participants (n = 20). All participants were classified into 3 groups: controls, patients with HIV but without SN, and patients with HIV-SN. Main Outcomes and Measures Comparison of corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal nerve fiber tortuosity, and corneal Langerhans cell density between healthy controls and patients with HIV with and without SN. Results All 40 participants were male, and most (≥70%) self-identified as white. Of the 20 patients with HIV, 14 (70%) had HIV-SN. This group was older (mean [SD] age, 57.7 [7.75] years) than the group without HIV-SN (mean [SD] age, 42.3 [7.26] years) and the controls (mean [SD] age, 53.8 [10.5] years). Corneal nerve fiber density was reduced in patients with HIV compared with the controls (26.7/mm2 vs 38.6/mm2; median difference, -10.37; 95.09% CI, -14.27 to -6.25; P < .001) and in patients with HIV-SN compared with those without (25.8/mm2 vs 30.7/mm2; median difference, -4.53; 95.92% CI, -8.85 to -0.26; P = .03). Corneal nerve branch density and corneal nerve fiber length were reduced in patients with HIV, but no differences were identified between those with neuropathy and without neuropathy (corneal nerve branch density: 95.83/mm2 for the controls vs 72.37/mm2 for patients with HIV; median difference, -24.53; 95.32% CI, -50.62 to -3.13; P = .01; and corneal nerve fiber length: 28.4 mm/mm2 for the controls vs 21.9 mm/mm2 for patients with HIV; median difference, -5.24; 95.09% CI, -8.83 to -1.38; P = .001). Tortuosity coefficient was increased in patients with HIV compared with controls (16.44 vs 13.95; median difference, 2.34; 95.09% CI, 0.31 to 4.65; P = .03) and in those with HIV-SN compared with those without (17.84 vs 14.18; median difference, 4.32; 95.92% CI, 0.68-9.23; P = .01). No differences were identified in corneal Langerhans cell density (19.84 cells/mm2 for the controls vs 41.43 cells/mm2 for patients with HIV; median difference, 9.38; 95% CI, -12.51 to 26.34; P = .53). Conclusions and Relevance In vivo corneal confocal microscopy could be used in the assessment of HIV-SN, but larger studies are required to confirm this finding.
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Affiliation(s)
| | | | | | - Jan Vollert
- BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
| | - Christoph Maier
- BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
| | - Dietrich Strum
- BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
| | - Marc Schargus
- Department of Ophthalmology, University Eye Hospital, Dusseldorf, Germany
| | - Tunde Peto
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, England6University College London Institute of Ophthalmology, London, England7Queen's University Belfast, Belfast, Northern Ireland
| | - Scott Hau
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, England6University College London Institute of Ophthalmology, London, England
| | - Reena Chopra
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, England6University College London Institute of Ophthalmology, London, England
| | - Rayaz A Malik
- Faculty of Medicine, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar8Institute of Cardiovascular Sciences, Cardiac Centre, School of Medicine, University of Manchester, Manchester, England
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25
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Genetics of HIV-associated sensory neuropathy and related pain in Africans. J Neurovirol 2017; 23:511-519. [PMID: 28560631 DOI: 10.1007/s13365-017-0532-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/31/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
Despite the use of safer antiretroviral medications, the rate of HIV-associated sensory neuropathy (HIV-SN), the most common neurological complication of HIV, remains high. This condition is often painful and has a negative effect on quality of life. Up to 90% of those with HIV-SN experience pain for which there is no effective analgesic treatment. Genetic factors are implicated, but there is a lack of a comprehensive body of research for African populations. This knowledge gap is even more pertinent as Africans are most affected by HIV. However, recent studies performed in Southern African populations have identified genes displaying potential as genetic markers for HIV-SN and HIV-SN-associated pain in Africans. Here, we review the published studies to describe current knowledge of genetic risk factors for this disease in Africa.
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