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

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Peripheral neuropathy is a common complication of Human Immunodeficiency Virus (HIV) infection.
• Under-diagnosis of neuropathy is prevalent in resource-limited settings.
• Effective screening tools are needed for early detection.

Purpose of the Study:

• To evaluate the utility of screening tools administered by nonphysician healthcare workers (HCW).
• To assess the role of quantitative sensory testing (QST) by trained staff.
• To identify moderate/severe neuropathy in HIV-infected outpatients.

Main Methods:

• 240 HIV-infected outpatients were enrolled using 2-stage cluster randomized sampling.
• HCWs administered various screening tools; trained staff performed QST.
• Tools were validated against clinical diagnosis of neuropathy.

Main Results:

• 18% of participants had moderate/severe neuropathy.
• Screening tests demonstrated 76% sensitivity and high negative predictive values (84-92%).
• QST showed lower sensitivity but higher specificity compared to screening tests.

Conclusions:

• Screening tests administered by HCWs are effective and promising for large-scale implementation.
• These tools can improve the diagnosis of peripheral neuropathy in resource-limited areas.
• QST is valuable for research purposes in diagnosing neuropathy.