Optimizing measures of HIV-associated neuropathy

Area of Science:

• Neurology
• Infectious Diseases
• Clinical Assessment

Background:

• Distal symmetric polyneuropathy (DSP) is prevalent in HIV patients and often involves autonomic dysfunction.
• Current tools for measuring HIV-DSP lack autonomic indices, necessitating optimized assessment methods.

Purpose of the Study:

• To optimize the Total Neuropathy Score (TNS) and Composite Autonomic Severity Score (CASS) for accurate assessment in HIV-DSP.
• To evaluate the validity and internal consistency of modified TNS and CASS versions.

Main Methods:

• 102 HIV-infected adults underwent neurological examinations, nerve conduction studies, quantitative sensory testing (QST), and autonomic function tests.
• Modifications to TNS and CASS were assessed for validity against original measures and internal consistency.

Main Results:

• The commonly used TNS for HIV-DSP was found valid but improved by excluding QST and incorporating autonomic indices.
• A modified CASS (M-CASS), designed for detecting milder impairment, demonstrated validity in HIV patients.

Conclusions:

• A revised TNS, excluding QST and integrating autonomic indices, is recommended as the optimal tool for HIV-DSP assessment.
• The M-CASS is confirmed as a valid and sensitive measure for evaluating autonomic impairment in individuals with HIV.