Bethasiwi Purbasari, Shahdevi Nandar Kurniawan, Machlusil Husna, Didi Candradikusuma, Harun Al-Rasyid
  MNJ, pp. 21-29  


Background: HIV/AIDS is a worldwide pandemic. Peripheral neuropathy is the most common neurologic complication with distal sensory polyneuropathy (HIV-DSP) as the most frequent form of manifestation. HIV-DSP is one of the major causes of global pain morbidity and often undiagnosed earlier, resulting in treatment given when HIV-DSP grade is already severe. Early detection is imperative to prevent the progression of HIV-DSP and improve patient’s quality of life. Polyneuropathy score, 10-g Semmes-Weinstein Monofilament (SWM) and vibration perception threshold (VPT)-quantitative sensory testing (QST) are considered to be potential candidates for HIVDSP screening tool.
Objective: To measure the reability of Polyneuropathy Score, SWM and VPT- QST in diagnosing HIV-DSP.
Methods: This research is a descriptive study with cross-sectional design. Research was conducted on 77 patients of HIV/AIDS outpatient clinic in RS Saiful Anwar (RSSA) during November 2016 - April 2017 (n = 77). Patients were screened for HIV-DSP by using polyneuropathy score, such as: Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Scoring Sysytem (TCSS), Brief Peripheral Neuropathy Score (BPNS), SWM, and VPT-QST. Sensitivity, specificity, positive predictive value and negative predictive value of BPNS, TCSS, MNSI, SWM and VPT-QST are analyzed using cross tabulation. Area under receiver operating characteristic (ROC) curve analysis was used to measure diagnostic accuracy of each tools. SPSS 19.0 was used for statistical analysis.
Results: TCSS had a sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio, negative likelihood ratio, and accuracy as much as: 70%, 97%, 97%, 74%, 23,33, 0,28 and 83%. The result of TCSS analysis using ROC showed that TCSS had excellent diagnostic value with AUC (Area Under Curve) of 0.89 (95%CI 82%-96,5%). The AUC of BPNS score, monofilamen and VPT-QST respectively: 0,469, 0,194, and 0,189.
Conclusion: The result of the HIV-DSP diagnostic test using TCSS score has the best value compared to other tools.


Distal Sensory Polineuropathy HIV, TCSS, Michigan, BPNS, Monofilamen, QST-VPT

Full Text:



World Health Organization. World Health Observatory (WHO) Data: HIV/AIDS. www.who.int/gho/hiv/en/. Accessed on 7 May 2016, 09.35

Joint United Nations Programme on HIV/AIDS. Global report 2012: Unaids report on the global AIDS epidemic. Joint United Nations Programme on HIV/AIDS, 2013

Kementerian Kesehatan Republik Indonesia – Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan. Pedoman nasional tatalaksana klinis infeksi hiv dan terapi antiretroviral; 2011.1-2

Unicef Indonesia. Responding to hiv and aids. issue briefs; oktober 2012.1-3

Letendre SL, Ellis RJ, Everall I, Ances B, Bharti A, McCutchan. A. neurologic complications of hiv 37 disease and their treatment. international aids societyusa: topics in hiv medicine; 2009.46-56. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19401607

Duarte AG, Papp JR, Simpson DM. Diagnosis and management of hiv-associated neuropathy. Neurol Clin 26, Elsevier saunders; 2008.821-832. DOI: 10.1016/j.ncl.2008.04.001

Kamerman PR, Wadley AL, Cherry CL. Hivassociated sensory neuropathy: risk factors and genetics. Curr Pain Headache Rep; 2012.16:226-36. DOI: 10.1007/s11916-012-0257-z

Beadles WI, Jahn A, Weigel R, Clutterbuck D. Peripheral neuropathy in hiv-positive patients at an antiretroviral clinic in lilongwe, malawi. Trop Doet; 2009.39:78-80. DOI: https://doi.org/10.1258/td.2008.080213

Morgello S, Estanislao L, Simpson D, Geraci A, DiRocco A., Gerita P. Manhattan hiv brain bank. hivassociated distal sensory peripheral neuropathy in the era of highly active antiretroviral theraphy. the manhattan hiv brain bank. Arch Neurol; 2004.61:153161

Shikuma C, Gerschenson M, Ananworanich J, Valeour V, Teeratakulpisarn N, Jadwattanakul T, et al. SEARCH 003 protocol team. Determinants of epidermal nerve fiber density in antiretroviral-naïve HIV-infected individuals. HIV Med; 2012.13:602-608

Ellis RJ, Rosario D, Clifford DB, McArthur JC, Simpson D, Alexander T, Gelman BB, Vaida F, Collier A., Marra CM, Ances B, Atkinson JH, Dworkin RH, Morgello S, Grant I. Continued high prevalence and adverse clinical impact of human immunodeficiency virus associated sensory neuropathy in the era of combination antiretroviral theraphy: the charter study. Arch Neurol; 2010.67:552-58. DOI: 10.1001/archneurol.2010.76

Maritz J, Benatar M, Dave JA., Harrison TB, Badri M, Levitt NS, Heckmann JM. Hiv neuropathy in south african: frequency, characteristics, and risk factors. Muscle Nerve; 2010.41:599-606. DOI: 10.1002/mus.21535

Keltner JR, Vaida F, Ellis RJ, Moeller-Bertram T, Fitzsimmons C, Duarte NA, Robinson-Papp J, Dworkin RH, Clifford DB, Mcarthur JC, Simpson DM, Collier AC, Marra CM, Atkinson JH, Grant I. Health-related quality of life 'well-being' in hiv distal neuropathic pain is more strongly associated with depression severity than with pain intensity. Psychosomatics; 2012.53:380-86

Phillips TJ, Cherryl CL, Cox S, Marshall SJ, Rice ASC. Pharmacological treatment of painful hivassociated sensory neuropathy: a systematic review and metaanalysis of randomized controlled trials. PloS One; 2010.5:e14433. DOI: 10.1371/journal.pone.0014433

Brew BJ. The peripheral nerve complication of human immunodeficiency virus (hiv) infection. Muscle Nerve; 2003.28:542-552

Malessa R, Agelink M, Himmelmann M, Kloss T, Mertins L, Brockmeyer N. Nerve conduction changes in asymptomatic hiv-1 seropositive individuals in the absence of other risk factors for neuropathy. Electromyogr Clin Neurophysiol; 1996.26:3-8. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8654319

Barohn R, Gronseth G, Amato A., et al. Cerebrospinal fluid and nerve conduction abnormalities in hiv positive individuals. J Neurol Sci; 1996.136:81-5

Phillips TJC, Brown M, Ramirez JD, Perkins J, Woldeamanuel YW, Williams AC.de C, et al. Sensory, psychological, and metabolic dysfunction in hiv-associated peripheral neuropathy: a cross sectional deep profiling study. PAIN; 2014.155:1846-60. DOI: 10.1016/j.pain.2014.06.014

Cettomal D, Kwasa J, Kendi C, Birbeck GL, Price RW, Bukusi EA, et al. Utility of quantitative sensory testing and screening tools in identifying hivassociated peripheral neuropathy in western kenya: pilot testing. PLoS One; 2010.5:e14256. DOI: 10.1371/journal.pone.0014256

Nebuchennykh M, Løseth S, Lindal S, Mellgren SI. The value of skin biopsy with recording of intraepidermal nerve fiber density and quantitative sensory testing in the assessment of small fiber involvement in patients with different causes of polyneuropathy. J Neurol; 2009.256:1067-75. DOI: 10.1007/s00415-009-5065-y

Simpson DM, Kitch D, Evans SR, et. al. HIV neuropathy natural history cohort study: assesment measures and risk factors. Neurology; 2006.66(11): 1679-87. DOI: 10.1212/01.wnl.0000218303.48113.5d

United States Department of Veteran Affairs. Peripheral Neuropathy and HIV – HIV/AIDS. http://www.hiv.va.gov/provider/manualprimarycare/peripheral-neuropathy-tool1.asp.2010.

Ellis RJ, Evans SR, Clifford DB, et al. Clinical validation of the neuroscreen. J Neurovirol; 2005.11(6): 503-11. DOI: 10.1080/13550280500384966

Muntean C, Cătălin B, Tudorică V, Moța M. Efficiency of michigan neuropathy screening instrument and nerve conduction studies for diagnosis of diabetic distal symmetric polyneuropathy. Rom J Diabetes Nutr Metab Dis; 2016.23(1):055065. DOI: 10.1515/rjdnmd-2016-0007

Bril V, Tomioka S, Buchanan RA, Perkins BA. Complications reliability and validity of the modified toronto clinical neuropathy score in diabetic sensorimotor polyneuropathy. journal compilation. Diabetes UK. Diabetic Medicine; 2009.26:240–246. DOI: 10.1111/j.1464-5491.2009.02667.x

Mete T, Aydin Y, Saka M, Yavuz HC, Bilen S, Yalcin Y, et al. Comparison of efficiencies of michigan neuropathy screening instrument, neurothesiometer, and electromyography for diagnosis of diabetic neuropathy. International Journal of Endocrinology: 821745. 2013. DOI: 10.1155/2013/821745

Herman WH, Pop-Busui R, Braffet BH, Martin cl, cleary pa, albers jw et al. use of the michigan neuropathy screening instrument as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the diabetes control an complications trial/epidemiology of diabetes interventions and complications. Diabet Med; 2012.29(7): page 937-944. DOI: 10.1111/j.14645491.2012.03644.x.

Moghtaderi A, Bakhshipour A, Rashidi H. Validation of michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clinical Neurology and Neurosurgery 108; 2006.477-81. DOI: 10.1016/j.clineuro.2005.08.003

Craig BA., Strauss MB, Daniller A, Miller SS. Foot sensation testing in the patient with diabetes: introduction of the quick & easy assessment tool. Wounds: 2013.26;(8)221-31. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25860638

Ponirakis G, Odriozola MN, Odriozola S, Petropoulos IN, Azmi IN, Fadavi H, et. al. NerveCheck: an inexpensive quantitative sensory testing device for patients with diabetic neuropathy. International Diabetes Federation. Diabetes Res Clin Pract; 2016. DOI: 10.1016/j.diabres.2015.12.023

Dubey TN, Raghuvanshi SS, Sharma H, Saxena R. HIV neuropathy in pre-haart patients and it’s correlation with risk factors in central india. Neurology India; 2013.61(5):478-80. DOI: 10.4103/0028-3886.121912

Sithinamsuwan P, Punthanamongkol S, Valcour V, Onsanit S, Nidhinandana S, Thitivichianlert S, et. al. Frequency and characteristic of hiv-associated sensory neuropathy among hiv patients in bangkok, thailand. J Acquir Immune Defic Syndr; 2008.49(4):456-58. DOI: [10.1097/QAI.0b013e318186eb03]

Konchalard K, Wangphonpattanasiri K. Clinical and electrophysiologic evaluation of peripheral neuropathy in a group of hiv-infected patients in thailand. J Med Assoc Thai; 2007.90(4):774-80

Luma HN, Tchaleu BCN, Doualla MS, Temfack E, Sopouassi VNK, Mapoure YN, et al. Hiv-associated sensory neuropathy in hiv-1 infected patients at the douala general hospital in cameroon: a cross sectional study. AIDS Research and Theraphy; 2012.9:35. DOI: [10.1186/1742-6405-9-35]

Cettomai D, Kwasam JK, Birbeck GL, Price RW, Cohen CR, Bukusi EA., et al. Screening for hivassociated peripheral neuropathy in resource-limited setting. Muscle Nerve; 2013.48:516-24. DOI: [10.1002/mus.23795]

Nienov OH, Dias LS, Parisi MCR, Schmid H. Sensitivity and specificity of neuropathy diabetes score, neuropathy symptoms score, diabetic neuropathy score and esthesiometry compared with the gold standards michigan neuropathy screening instrument (mnsi) and beck depression inventory (BDI); 2015.7 (Suppl 1):A196. DOI: [10.1186/17585996-7-S1-A199]

Woldeamanuel YW, Kamerman PR, Veliotes DG, Phillips TJ, Asboe D, Boffito M, et. al. 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. Clinical hiv-associated neuropathy tool (chant); 2016. DOI: 10.1371/journal.pone.0164994

Meijer JWG, Smit AJ, Lefrandt JD, Van Der Hoeven JH, Hoogenberg K, Links TP. Back to basics in diagnosing diabetic polyneuropathy with the tuning fox. diabetes care; 2005.28:2201-5. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16123490

Govind BT, Jyoti KT, Prakash MS, Milind VB. Clinical and electrophysiologic evaluation of peripheral neuropathy in hiv infected patients. National Journal of Basic Medical Sciences; 2014.4(4):227-33

Purbasari B, Anggraini VA, Pratiwi MD, Husna M, Kurniawan SN. Diagnostic test of toronto and modified toronto scoring, monofilament test, and vibrate sensation test using 128 hz tuning fork for diabetic polyneuropathy. Malang Neurology Journal; 2018.4:25-34. DOI: 10.21776/ub.mnj.2018.004.01.5


  • There are currently no refbacks.