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感染艾滋病毒的人数不成比例。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。最近治疗与艾滋病毒相关的神经性疼痛的临床试验结果令人失望，提出了一个问题，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适合研究人群。初步数据表明，HIV相关神经病变（包括疼痛）的临床表现可能存在种族和民族差异。该项目的目标是更好地定义这些差异，并探索其神经生物学和社会文化基础。具体目标是：1。确定HIV相关神经病变的临床和神经生理学特征在种族和民族之间是否存在差异2。确定常用的疼痛量表是否充分反映了少数、低文化程度的HIV相关远端感觉性多发性神经病（HIV-DSP）患者的疼痛体验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HAART时代HIV-DSP的特征性外周神经和皮肤活检病理学是否随人种或种族而变化，将对国家NeuroAIDS组织联盟和CNS HIV抗逆转录病毒效应研究收集的数据进行回顾性分析。今后，将招募主要是少数民族患者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系统评估和缺陷量化;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。 公共卫生相关性：神经病变是HIV的常见并发症，其显著降低生活质量，并且没有FDA批准的治疗方法。艾滋病毒现在不成比例地影响少数民族，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.