Optimizing measures of HIV-associated neuropathy

Muscle Nerve. 2015 Jan;51(1):56-64. doi: 10.1002/mus.24282. Epub 2014 Nov 21.


Introduction: Distal symmetric polyneuropathy (DSP) is common in HIV and is associated with autonomic impairment. However tools to measure HIV-DSP do not include autonomic indices. We sought to optimize the Total Neuropathy Score (TNS) and the Composite Autonomic Severity Score (CASS) for use in HIV.

Methods: HIV-infected adults (n = 102) underwent neurologic examination, quantitative sensory testing (QST), nerve conduction studies, and autonomic testing. Modifications of the TNS and CASS were assessed for validity based on correlation with the original measure and internal consistency.

Results: The TNS version commonly used in HIV-DSP is valid, but it is improved by elimination of QST and addition of autonomic indices. A modified version of the CASS (M-CASS) which was designed for sensitivity to milder impairment was also valid.

Conclusions: A modified TNS that excludes QST and includes autonomic indices is optimal for HIV-DSP. The M-CASS is a valid measure of autonomic impairment in HIV.

Keywords: Composite Autonomic Severity Score; HIV; Total Neuropathy Score; autonomic; neuropathy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Associated Nephropathy / complications
  • AIDS-Associated Nephropathy / diagnosis*
  • Adult
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neural Conduction / physiology
  • Neurologic Examination
  • Pain / etiology
  • Peripheral Nerves / pathology*
  • Peripheral Nerves / physiopathology*
  • Severity of Illness Index