Cargando…
Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings
HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource set...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072607/ https://www.ncbi.nlm.nih.gov/pubmed/27764177 http://dx.doi.org/10.1371/journal.pone.0164994 |
_version_ | 1782461422837432320 |
---|---|
author | Woldeamanuel, Yohannes W. Kamerman, Peter R. Veliotes, Demetri G. A. Phillips, Tudor J. Asboe, David Boffito, Marta Rice, Andrew S. C. |
author_facet | Woldeamanuel, Yohannes W. Kamerman, Peter R. Veliotes, Demetri G. A. Phillips, Tudor J. Asboe, David Boffito, Marta Rice, Andrew S. C. |
author_sort | Woldeamanuel, Yohannes W. |
collection | PubMed |
description | HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study–HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman’s Rho), and inter-tester concordance > 0.93 (Spearman’s Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet pain can be used to identify those with neuropathic pain. |
format | Online Article Text |
id | pubmed-5072607 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-50726072016-10-27 Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings Woldeamanuel, Yohannes W. Kamerman, Peter R. Veliotes, Demetri G. A. Phillips, Tudor J. Asboe, David Boffito, Marta Rice, Andrew S. C. PLoS One Research Article HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study–HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman’s Rho), and inter-tester concordance > 0.93 (Spearman’s Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet pain can be used to identify those with neuropathic pain. Public Library of Science 2016-10-20 /pmc/articles/PMC5072607/ /pubmed/27764177 http://dx.doi.org/10.1371/journal.pone.0164994 Text en © 2016 Woldeamanuel et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Woldeamanuel, Yohannes W. Kamerman, Peter R. Veliotes, Demetri G. A. Phillips, Tudor J. Asboe, David Boffito, Marta Rice, Andrew S. C. Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings |
title | Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings |
title_full | Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings |
title_fullStr | Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings |
title_full_unstemmed | Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings |
title_short | Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings |
title_sort | development, validation, and field-testing of an instrument for clinical assessment of hiv-associated neuropathy and neuropathic pain in resource-restricted and large population study settings |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072607/ https://www.ncbi.nlm.nih.gov/pubmed/27764177 http://dx.doi.org/10.1371/journal.pone.0164994 |
work_keys_str_mv | AT woldeamanuelyohannesw developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings AT kamermanpeterr developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings AT veliotesdemetriga developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings AT phillipstudorj developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings AT asboedavid developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings AT boffitomarta developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings AT riceandrewsc developmentvalidationandfieldtestingofaninstrumentforclinicalassessmentofhivassociatedneuropathyandneuropathicpaininresourcerestrictedandlargepopulationstudysettings |