Noninvasive Imaging Technique Could Help Diagnose, Monitor HIV-Associated Sensory Neuropathy

Patients with HIV-associated sensory neuropathy have a decrease in corneal nerve fiber density and an increase in corneal nerve tortuosity.

In vivo corneal confocal microscopy (IVCCM) is a useful technique to assess HIV-associated sensory neuropathy (HIV-SN), a new study published in JAMA Ophthalmology suggests.

IVCCM is a noninvasive ophthalmic imaging technique that could help in the diagnosis and longitudinal monitoring of patients with HIV-SN.

For the study, investigators sought to assess changes in corneal nerve fiber structure and Langerhans cell density in patients with HIV-SN using corneal confocal microscopy.

A total of 40 participants were included in the study, all of whom were male. Twenty were HIV-positive, and recruited from adult outpatient clinics at Chelsea and Westminster Hospital NHS Foundation Trust in England. The prospective, cross-sectional cohort study was conducted between July 2015 and September 2015.

Patients received a structured clinical examination, validated symptom questionnaires, and the Clinical HIV-Associated Neuropathy Tool. The results from patients with HIV were then compared with their healthy control counterparts.

All participants were classified into either the control arm, HIV-positive without SN arm, or HIV-SN arm.

The results of the study showed that 14 of the 20 HIV-positive participants had HIV-SN. Corneal nerve fiber density was reduced in patients with HIV compared with the controls, and in patients with HIV-SN compared with those without it.

The investigators also found that corneal nerve branch density and corneal nerve fiber length were reduced in patients with HIV, but no differences were observed between participants with neuropathy and those without it.

The tortuosity coefficient was higher in patients with HIV compared with the control group, as well as in those with HIV-SN compared with those without it. No differences were observed in corneal Langerhans cell density.

“In vivo corneal confocal microscopy could be used in the assessment of HIV-SN, but larger studies are required to confirm this finding,” the authors concluded.

Peripheral nerve disorders are among the most frequent neurological complications of HIV-infection, according to Johns Hopkins Medicine. HIV neuropathy can manifest in various ways, and the number of patients with this disorder is increasing worldwide.