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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS066789-05
Application #
8512818
Study Section
Special Emphasis Panel (ZNS1-SRB-G (36))
Program Officer
Wong, May
Project Start
2009-08-15
Project End
2014-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
5
Fiscal Year
2013
Total Cost
$175,644
Indirect Cost
$13,011
Name
Icahn School of Medicine at Mount Sinai
Department
Neurology
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Robinson-Papp, Jessica; George, Mary Catherine; Dorfman, David et al. (2015) Barriers to Chronic Pain Measurement: A Qualitative Study of Patient Perspectives. Pain Med 16:1256-64
Robinson-Papp, Jessica; George, Mary Catherine (2015) Trust and the ethics of chronic pain management in HIV. J Assoc Nurses AIDS Care 26:509-13
Robinson-Papp, Jessica; Sharma, Sandeep; Dhadwal, Neetu et al. (2015) Optimizing measures of HIV-associated neuropathy. Muscle Nerve 51:56-64
Robinson-Papp, Jessica; George, Mary Catherine; Wongmek, Arada et al. (2015) The Quantitative Analgesic Questionnaire: A Tool to Capture Patient-Reported Chronic Pain Medication Use. J Pain Symptom Manage 50:381-6
Robinson-Papp, Jessica; Sharma, Sandeep; Simpson, David M et al. (2013) Autonomic dysfunction is common in HIV and associated with distal symmetric polyneuropathy. J Neurovirol 19:172-80
Robinson-Papp, Jessica; Sharma, Sandeep K (2013) Autonomic neuropathy in HIV is unrecognized and associated with medical morbidity. AIDS Patient Care STDS 27:539-43
Robinson-Papp, Jessica; Elliott, Kathryn; Simpson, David M et al. (2012) Problematic prescription opioid use in an HIV-infected cohort: the importance of universal toxicology testing. J Acquir Immune Defic Syndr 61:187-93
Robinson-Papp, Jessica; Gelman, Benjamin B; Grant, Igor et al. (2012) Substance abuse increases the risk of neuropathy in an HIV-infected cohort. Muscle Nerve 45:471-6
Keltner, John R; Vaida, Florin; Ellis, Ronald J et al. (2012) Health-related quality of life 'well-being' in HIV distal neuropathic pain is more strongly associated with depression severity than with pain intensity. Psychosomatics 53:380-6
Fellows, Robert P; Byrd, Desiree A; Elliott, Kathryn et al. (2012) Distal sensory polyneuropathy is associated with neuropsychological test performance among persons with HIV. J Int Neuropsychol Soc 18:898-907

Showing the most recent 10 out of 14 publications