HIV-associated Neuropathy: Ethnic Disparities and Pathogenesis

HIV 相关神经病：种族差异和发病机制

• 批准号: 7910480
• 负责人: Jessica Robinson-Papp
• 金额: $ 17.01万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7910480
• 关键词: Accounting; Affect; Anti-Retroviral Agents; Autopsy; Biopsy; Biopsy Specimen; Brain; Characteristics; Clinical; Clinical Treatment; Clinical Trials; Complication; Data; Distal; Ethnic Origin; Ethnic group; FDA approved; Goals; HIV; HIV Infections; HIV Seropositivity; Hypersensitivity skin testing; Knowledge; Measures; Minority; National NeuroAids Tissue Consortium; Neural Conduction; Neurologic; Neuropathy; Neurosciences; Pain; Pathogenesis; Pathologic; Pathology; Patients; Peripheral Nerves; Pharmaceutical Preparations; Polyneuropathy; Population; Prevalence; Quality of life; Race; Recruitment Activity; Reporting; Research; Research Personnel; Sensory; Signs and Symptoms; Skin; Specimen; Symptoms; Testing; Woman; advanced disease; autonomic neuropathy; effective therapy; experience; immunopathology; instrument; literacy; painful neuropathy; programs; public health relevance; racial and ethnic; racial/ethnic difference; research study

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.

描述（由申请人提供）：现在，少数族裔和妇女在新增艾滋病毒感染者中所占比例过高。神经病变是 HIV 最常见的神经系统并发症，高达 60% 的晚期疾病患者会出现这种情况。神经病通常会带来疼痛，并对生活质量产生重大负面影响。最近治疗与艾滋病相关的神经性疼痛的临床试验结果令人失望，这引发了一个问题：研究药物是否确实缺乏疗效，或者用于测量疼痛的仪器是否不太适合所研究的人群。试点数据表明，艾滋病毒相关神经病的临床表现（包括疼痛）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它们的神经生物学和社会文化基础。具体目标是： 1. 确定种族和族裔群体之间 HIV 相关神经病的临床和神经生理学特征是否存在差异 2. 确定常用的疼痛量表是否充分反映少数民族、文化水平较低的 HIV 患者的疼痛经历相关远端感觉性多发性神经病 (HIV-DSP) 3. 确定自主神经病 (AN) 在 HIV 阳性少数群体中是否普遍存在 4. 确定 HIV-DSP 的特征性周围神经和皮肤活检病理学是否在 HIV 阳性人群中普遍存在HAART 时代因种族或民族而异。将对国家神经艾滋病组织联盟和 CNS HIV 抗逆转录病毒作用研究收集的数据进行回顾性分析。展望未来，将主要招募少数族裔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；使用经过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。将使用曼哈顿艾滋病毒脑库的尸检标本来研究周围神经病理学。 公共健康相关性：神经病变是 HIV 的常见并发症，会显着降低生活质量，并且 FDA 尚无批准的治疗方法。现在，艾滋病毒对少数族裔的影响尤为严重，因此，如果要开发出针对神经病变的有效治疗方法，就需要更多关于这些人群中艾滋病毒的临床和病理表现的信息，包括疼痛的报告。