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Evaluation of a clinical screening tool for HIV-associated sensory neuropathies

From Burnet Institute (Drs. Cherry and Wesselingh, and L. Lal), Melbourne; Infectious Diseases Unit (Drs. Cherry and Wesselingh), Alfred Hospital, Melbourne; Department of Medicine (Drs. Cherry and Wesselingh), Monash University, Melbourne, Australia; and Departments of Neurology and Epidemiology (J.C. McArthur), Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Dr Cherry, The Macfarlane Burnet Institute for Medical Research and Public Health, GPO Box 2284, Melbourne, Victoria 3001, Australia; e-mail: kate.cherry{at}med.monash.edu.au

Objective: To evaluate the performance characteristics of a brief clinical neuropathy screening tool for use in sensory neuropathies complicating HIV infection.

Methods: The authors assessed 80 patients using the Brief Peripheral Neuropathy Screen (BPNS). Patients were defined as having neuropathy if they had both symptoms and signs consistent with this diagnosis. All subjects underwent sensory threshold testing and lower limb epidermal nerve fiber quantification using punch skin biopsy as objective measures.

Results: Individuals defined as having neuropathy using the BPNS (n = 37) performed less well on sensory threshold testing than other HIV-infected individuals (p < 0.0001 for warming, cooling, and vibration) and also had lower distal calf epidermal nerve fiber densities (p < 0.0001). Individuals who had symptoms but no neuropathic signs (n = 13) did not perform differently on any objective testing compared with neuropathy-free individuals, supporting the decision to require signs as well as symptoms as an operational criterion for the diagnosis of neuropathy. Of the symptoms listed in the screening tool, the presence of numbness had the greatest diagnostic efficiency for identifying those with neuropathy.

Conclusion: The Brief Neuropathy Screening Tool (and the chosen definition of neuropathy) accurately detects those HIV-infected individuals with the greatest degree of peripheral nerve dysfunction and pathology. This is a valid neuropathy screening tool for use in the context of HIV infection, and is simple enough to be applicable in resource-limited settings.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 13 issue to find the title link for this article.

Supported by the US National Institutes of Health NIH NINDS (NS44807 [J.C.M.], NS49465 [J.C.M.]). C.L.C. was additionally supported by the National Health and Medical Research Council (NHMRC, Australia).

Disclosure: The authors report no conflicts of interest.

Received March 25, 2005. Accepted in final form August 25, 2005.

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