HIV-associated Neuropathy: Ethnic Disparities and Pathogenesis

描述(由申请人提供)：少数民族和妇女现在占新艾滋病毒感染人数的不成比例的比例。神经病变是艾滋病毒最常见的神经系统并发症，高达60%的晚期疾病患者会发生神经病变。神经病通常是痛苦的，可能会对生活质量产生重大的负面影响。最近治疗与艾滋病毒相关的神经病理性疼痛的临床试验结果令人失望，这引发了一个问题，即研究药物是否真的缺乏疗效，或者用于测量疼痛的仪器是否不太适合被研究的人群。试点数据表明，包括疼痛在内的艾滋病毒相关神经病变的临床表现可能存在种族和民族差异。这个项目的目标是更好地定义这些差异，并探索它们的神经生物学和社会文化基础。具体目标是：1.确定HIV相关神经病的临床和神经生理学特征是否在种族和民族之间存在差异2.确定常用的疼痛评分是否足以反映患有HIV相关的远端感觉神经多发性神经病(HIV-DSP)的少数民族、低识字率患者的疼痛经历3.确定自主神经病变(AN)是否在HIV阳性的少数族裔中普遍存在4.为了确定HAART时代HIV-DSP的特征周围神经和皮肤活检病理是否因种族或民族而异，将对国家神经艾滋病组织联合会和CNS HIV抗逆转录病毒效应研究收集的数据进行回顾性分析。展望未来，将招募以少数族裔为主的患者进行详细的神经学评估，包括：疼痛和症状分级的管理；详细的神经学评估和使用经过验证的仪器量化缺陷；神经生理学测试(神经传导研究、定量感觉测试和自主测试)；以及皮肤活检。将使用曼哈顿艾滋病毒脑库的尸检样本来研究周围神经病理。 公共卫生相关性：神经病是艾滋病毒的一种常见并发症，它显著降低了生活质量，目前还没有FDA批准的治疗方法。艾滋病毒现在对少数群体的影响不成比例，因此，如果要开发有效的神经病治疗方法，就需要更多关于这些人群的临床和病理表现的信息，包括疼痛的报告。

DESCRIPTION (provided by applicant): Minorities and women now account for a disproportionate number of new HIV infections. Neuropathy is the most common neurologic complication of HIV, occurring in up to 60% of patients with advanced disease. Neuropathy is commonly painful and can have a significant negative impact on quality of life. Recent clinical trials of treatment for neuropathic pain related to HIV have had disappointing results, raising the question of whether the study medications truly lack efficacy, or if the instruments used to measure pain were poorly suited to the population under study. Pilot data suggest there may be racial and ethnic differences in clinical manifestations of HIV-associated neuropathy, including pain. The goal of this project is to better define these differences and to explore their neuro-biologic and socio-cultural underpinnings. Specific aims are: 1. To determine whether there are differences between racial and ethnic groups in clinical and neurophysiologic features of HIV-associated neuropathy 2. To determine if commonly used pain scales adequately reflect the pain experience of minority, low-literacy patients with HIV-associated distal sensory polyneuropathy (HIV-DSP) 3. To determine whether autonomic neuropathy (AN) is prevalent in HIV-positive minorities 4. To determine whether the characteristic peripheral nerve and skin biopsy pathology of HIV-DSP in the HAART-era varies with race or ethnicity Retrospective analyses will be performed on data collected by the National NeuroAIDS Tissue Consortium and the CNS HIV Antiretroviral Effects Research Study. Going forward, predominantly minority patients will be recruited for detailed neurologic assessment including: administration of pain and symptom scales; detailed neurologic assessment and quantification of deficits using validated instruments; neurophysiologic testing (nerve conduction studies, quantitative sensory testing and autonomic testing); and skin biopsy. Peripheral nerve pathology will be studied using autopsy specimens from the Manhattan HIV Brain Bank. PUBLIC HEALTH RELEVANCE: Neuropathy is a common complication of HIV which significantly reduces quality of life, and for which there is no FDA-approved treatment. HIV now disproportionately affects minorities, so if effective treatments for neuropathy are to be developed, more information is needed about its clinical and pathologic manifestations in these populations, including the reporting of pain.