International Journal of STD & AIDS > Volume 18, Number 12 > Pp. 856-860

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Original research articles

Early detection of subclinical HIV sensory polyneuropathy using intraepidermal nerve fibre density quantification: association with HIV stage and surrogate markers

E Skopelitis, K Aroni, A N Kontos, K Konstantinou, P Kokotis, N Karandreas and T Kordossis

Department of Pathophysiology (AIDS Unit), Laikon General Hospital, School of Medicine, Athens, Greece; Department of Pathology, Laikon General Hospital, School of Medicine, Athens, Greece; Department of Pathophysiology (AIDS Unit), Laikon General Hospital, School of Medicine, Athens, Greece; Department of Statistics, Faculty of Medicine, Imperial College, St Mary's Campus, London, UK; Department of Neurology, Aeginition Hospital, School of Medicine, Athens, Greece; Department of Neurology, Aeginition Hospital, School of Medicine, Athens, Greece; Department of Pathophysiology (AIDS Unit), Laikon General Hospital, School of Medicine, Athens, Greece

The linear intraepidermal nerve fibre density (IENFD) and secondary branching were evaluated from skin biopsy of both the distal calf and the proximal thigh after staining with protein gene product 9.5 in 94 individuals of an HIV outpatient cohort. Possible correlations with clinical and electrophysiological evidence of distal sensory polyneuropathy (DSP), patients' demographics, antiretroviral history and HIV surrogate markers were analysed. Reduced IENFD was recognized in the majority of this population (mean ± standard deviation [SD] IENFD in the calf and the thigh was 3.19 ± 1.91 and 7.07 ± 3.5 fibres/mm, respectively). One-third of the patients with low IENFD had no clinical or electrophysiological evidence of DSP. The level of prior immunosuppression as expressed by lower nadir CD4 count, more advanced HIV stage and prior exposure to combinations of neurotoxic antiretrovirals was associated with more decreased IENFD. Increased SB was associated with symptomatic DSP.

Key Words: HIV • DISTAL SENSORY POLYNEUROPATHY • ANTIRETROVIRAL TOXIC NEUROPATHY • NADIR CD4 • IENF DENSITY

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