HIV-associated Neuropathy: Ethnic Disparities and Pathogenesis

少数民族和妇女现在在新感染艾滋病毒的人数中所占比例过高。神经病变是 HIV最常见的神经系统并发症，发生在高达60%的晚期疾病患者中。 神经病变通常是痛苦的，并可能对生活质量产生显着的负面影响。最近的临床 治疗与HIV有关的神经性疼痛的试验结果令人失望，提出了一个问题， 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很差 适合研究人群。初步数据表明，在临床上可能存在种族和民族差异。 HIV相关神经病变的表现，包括疼痛。这个项目的目标是更好地定义 这些差异，并探讨其神经生物学和社会文化基础。具体目标是： 1.为了确定种族和族裔群体之间在临床和 HIV相关神经病的神经生理学特征 2.为了确定常用的疼痛量表是否充分反映了少数民族的疼痛经历， 患有HIV相关远端感觉性多发性神经病（HIV-DSP）的低识字率患者 3.确定自主神经病变（AN）是否在HIV阳性的少数民族中普遍存在 4.为了确定是否特征性周围神经和皮肤活检病理HIV-DSP在 HAART时代因种族或民族而异 将对国家神经艾滋病组织联盟收集的数据进行回顾性分析 和CNS HIV抗逆转录病毒效应研究。展望未来，主要是少数民族患者将 招募进行详细的神经系统评估，包括：疼痛和症状量表的管理; 使用经验证的仪器进行详细的神经功能评估和缺陷量化;神经生理学 测试（神经传导研究、定量感觉测试和自主神经测试）;和皮肤活检。 将使用来自曼哈顿HIV脑库的尸检标本研究外周神经病理学。

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.