Use of corneal confocal microscopy to evaluate small nerve fibers in patients with human immunodeficiency virus

Harriet I. Kemp, Ioannis N. Petropoulos, Andrew S.C. Rice, Jan Vollert, Christoph Maier, Dietrich Strum, Marc Schargus, Tunde Peto, Scott Hau, Reena Chopra, Rayaz Malik

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Abstract

IMPORTANCE: Objective quantification of small fiber neuropathy in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy (HIV-SN) is difficult but needed for diagnosis and monitoring. In vivo corneal confocal microscopy (IVCCM) can quantify small fiber damage. OBJECTIVE: To establish whether IVCCM can identify an abnormality in corneal nerve fibers and Langerhans cells in patients with and without HIV-SN. DESIGN, SETTING, AND PARTICIPANTS: This prospective, cross-sectional cohort studywas conducted between July 24, 2015, and September 17, 2015. Twenty patients whowere HIV positivewere recruited from adult outpatient clinics at Chelsea andWestminster Hospital NHS Foundation Trust in England. These patients underwent IVCCM at Moorfields Eye Hospital NHS Foundation Trust in London, England, and the IVCCM imageswere analyzed atWeill Cornell Medicine-Qatar in Ar-Rayyan, Qatar. Patientswere given a structured clinical examination and completed validated symptom questionnaires and the Clinical HIV-Associated Neuropathy Tool. Results from patients with HIVwere compared with the results of the age- and sex-matched healthy control participants (n = 20). All participantswere classified into 3 groups: controls, patients with HIV but without SN, and patients with HIV-SN. MAIN OUTCOMES AND MEASURES: Comparison of corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal nerve fiber tortuosity, and corneal Langerhans cell density between healthy controls and patients with HIV with and without SN. RESULTS: All 40 participants were male, and most (≥70%) self-identified as white. Of the 20 patients with HIV, 14 (70%) had HIV-SN. This group was older (mean [SD] age, 57.7 [7.75] years) than the group without HIV-SN (mean [SD] age, 42.3 [7.26] years) and the controls (mean [SD] age, 53.8 [10.5] years). Corneal nerve fiber density was reduced in patients with HIV compared with the controls (26.7/mm2 vs 38.6/mm2; median difference, -10.37; 95.09% CI, -14.27 to -6.25; P < .001) and in patients with HIV-SN compared with those without (25.8/mm2 vs 30.7/mm2; median difference, -4.53; 95.92%CI, -8.85 to -0.26; P = .03). Corneal nerve branch density and corneal nerve fiber length were reduced in patients with HIV, but no differences were identified between those with neuropathy and without neuropathy (corneal nerve branch density: 95.83/mm2 for the controls vs 72.37/mm2 for patients with HIV; median difference, -24.53; 95.32%CI, -50.62 to -3.13; P = .01; and corneal nerve fiber length: 28.4 mm/mm2 for the controls vs 21.9 mm/mm2 for patients with HIV; median difference, -5.24; 95.09%CI, -8.83 to -1.38; P = .001). Tortuosity coefficient was increased in patients with HIV compared with controls (16.44 vs 13.95; median difference, 2.34; 95.09% CI, 0.31 to 4.65; P = .03) and in those with HIV-SN compared with those without (17.84 vs 14.18; median difference, 4.32; 95.92%CI, 0.68-9.23; P = .01). No differences were identified in corneal Langerhans cell density (19.84 cells/mm2 for the controls vs 41.43 cells/mm2 for patients with HIV; median difference, 9.38; 95%CI, -12.51 to 26.34; P = .53). CONCLUSIONS AND RELEVANCE: In vivo corneal confocal microscopy could be used in the assessment of HIV-SN, but larger studies are required to confirm this finding.

Original languageEnglish
Pages (from-to)795-799
Number of pages5
JournalJAMA Ophthalmology
Volume135
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

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Nerve Fibers
Confocal Microscopy
HIV
Langerhans Cells
Qatar
England
Cell Count
Ambulatory Care Facilities

ASJC Scopus subject areas

  • Ophthalmology

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Use of corneal confocal microscopy to evaluate small nerve fibers in patients with human immunodeficiency virus. / Kemp, Harriet I.; Petropoulos, Ioannis N.; Rice, Andrew S.C.; Vollert, Jan; Maier, Christoph; Strum, Dietrich; Schargus, Marc; Peto, Tunde; Hau, Scott; Chopra, Reena; Malik, Rayaz.

In: JAMA Ophthalmology, Vol. 135, No. 7, 01.07.2017, p. 795-799.

Research output: Contribution to journalArticle

Kemp, HI, Petropoulos, IN, Rice, ASC, Vollert, J, Maier, C, Strum, D, Schargus, M, Peto, T, Hau, S, Chopra, R & Malik, R 2017, 'Use of corneal confocal microscopy to evaluate small nerve fibers in patients with human immunodeficiency virus', JAMA Ophthalmology, vol. 135, no. 7, pp. 795-799. https://doi.org/10.1001/jamaophthalmol.2017.1703
Kemp, Harriet I. ; Petropoulos, Ioannis N. ; Rice, Andrew S.C. ; Vollert, Jan ; Maier, Christoph ; Strum, Dietrich ; Schargus, Marc ; Peto, Tunde ; Hau, Scott ; Chopra, Reena ; Malik, Rayaz. / Use of corneal confocal microscopy to evaluate small nerve fibers in patients with human immunodeficiency virus. In: JAMA Ophthalmology. 2017 ; Vol. 135, No. 7. pp. 795-799.
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abstract = "IMPORTANCE: Objective quantification of small fiber neuropathy in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy (HIV-SN) is difficult but needed for diagnosis and monitoring. In vivo corneal confocal microscopy (IVCCM) can quantify small fiber damage. OBJECTIVE: To establish whether IVCCM can identify an abnormality in corneal nerve fibers and Langerhans cells in patients with and without HIV-SN. DESIGN, SETTING, AND PARTICIPANTS: This prospective, cross-sectional cohort studywas conducted between July 24, 2015, and September 17, 2015. Twenty patients whowere HIV positivewere recruited from adult outpatient clinics at Chelsea andWestminster Hospital NHS Foundation Trust in England. These patients underwent IVCCM at Moorfields Eye Hospital NHS Foundation Trust in London, England, and the IVCCM imageswere analyzed atWeill Cornell Medicine-Qatar in Ar-Rayyan, Qatar. Patientswere given a structured clinical examination and completed validated symptom questionnaires and the Clinical HIV-Associated Neuropathy Tool. Results from patients with HIVwere compared with the results of the age- and sex-matched healthy control participants (n = 20). All participantswere classified into 3 groups: controls, patients with HIV but without SN, and patients with HIV-SN. MAIN OUTCOMES AND MEASURES: Comparison of corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal nerve fiber tortuosity, and corneal Langerhans cell density between healthy controls and patients with HIV with and without SN. RESULTS: All 40 participants were male, and most (≥70{\%}) self-identified as white. Of the 20 patients with HIV, 14 (70{\%}) had HIV-SN. This group was older (mean [SD] age, 57.7 [7.75] years) than the group without HIV-SN (mean [SD] age, 42.3 [7.26] years) and the controls (mean [SD] age, 53.8 [10.5] years). Corneal nerve fiber density was reduced in patients with HIV compared with the controls (26.7/mm2 vs 38.6/mm2; median difference, -10.37; 95.09{\%} CI, -14.27 to -6.25; P < .001) and in patients with HIV-SN compared with those without (25.8/mm2 vs 30.7/mm2; median difference, -4.53; 95.92{\%}CI, -8.85 to -0.26; P = .03). Corneal nerve branch density and corneal nerve fiber length were reduced in patients with HIV, but no differences were identified between those with neuropathy and without neuropathy (corneal nerve branch density: 95.83/mm2 for the controls vs 72.37/mm2 for patients with HIV; median difference, -24.53; 95.32{\%}CI, -50.62 to -3.13; P = .01; and corneal nerve fiber length: 28.4 mm/mm2 for the controls vs 21.9 mm/mm2 for patients with HIV; median difference, -5.24; 95.09{\%}CI, -8.83 to -1.38; P = .001). Tortuosity coefficient was increased in patients with HIV compared with controls (16.44 vs 13.95; median difference, 2.34; 95.09{\%} CI, 0.31 to 4.65; P = .03) and in those with HIV-SN compared with those without (17.84 vs 14.18; median difference, 4.32; 95.92{\%}CI, 0.68-9.23; P = .01). No differences were identified in corneal Langerhans cell density (19.84 cells/mm2 for the controls vs 41.43 cells/mm2 for patients with HIV; median difference, 9.38; 95{\%}CI, -12.51 to 26.34; P = .53). CONCLUSIONS AND RELEVANCE: In vivo corneal confocal microscopy could be used in the assessment of HIV-SN, but larger studies are required to confirm this finding.",
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T1 - Use of corneal confocal microscopy to evaluate small nerve fibers in patients with human immunodeficiency virus

AU - Kemp, Harriet I.

AU - Petropoulos, Ioannis N.

AU - Rice, Andrew S.C.

AU - Vollert, Jan

AU - Maier, Christoph

AU - Strum, Dietrich

AU - Schargus, Marc

AU - Peto, Tunde

AU - Hau, Scott

AU - Chopra, Reena

AU - Malik, Rayaz

PY - 2017/7/1

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N2 - IMPORTANCE: Objective quantification of small fiber neuropathy in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy (HIV-SN) is difficult but needed for diagnosis and monitoring. In vivo corneal confocal microscopy (IVCCM) can quantify small fiber damage. OBJECTIVE: To establish whether IVCCM can identify an abnormality in corneal nerve fibers and Langerhans cells in patients with and without HIV-SN. DESIGN, SETTING, AND PARTICIPANTS: This prospective, cross-sectional cohort studywas conducted between July 24, 2015, and September 17, 2015. Twenty patients whowere HIV positivewere recruited from adult outpatient clinics at Chelsea andWestminster Hospital NHS Foundation Trust in England. These patients underwent IVCCM at Moorfields Eye Hospital NHS Foundation Trust in London, England, and the IVCCM imageswere analyzed atWeill Cornell Medicine-Qatar in Ar-Rayyan, Qatar. Patientswere given a structured clinical examination and completed validated symptom questionnaires and the Clinical HIV-Associated Neuropathy Tool. Results from patients with HIVwere compared with the results of the age- and sex-matched healthy control participants (n = 20). All participantswere classified into 3 groups: controls, patients with HIV but without SN, and patients with HIV-SN. MAIN OUTCOMES AND MEASURES: Comparison of corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal nerve fiber tortuosity, and corneal Langerhans cell density between healthy controls and patients with HIV with and without SN. RESULTS: All 40 participants were male, and most (≥70%) self-identified as white. Of the 20 patients with HIV, 14 (70%) had HIV-SN. This group was older (mean [SD] age, 57.7 [7.75] years) than the group without HIV-SN (mean [SD] age, 42.3 [7.26] years) and the controls (mean [SD] age, 53.8 [10.5] years). Corneal nerve fiber density was reduced in patients with HIV compared with the controls (26.7/mm2 vs 38.6/mm2; median difference, -10.37; 95.09% CI, -14.27 to -6.25; P < .001) and in patients with HIV-SN compared with those without (25.8/mm2 vs 30.7/mm2; median difference, -4.53; 95.92%CI, -8.85 to -0.26; P = .03). Corneal nerve branch density and corneal nerve fiber length were reduced in patients with HIV, but no differences were identified between those with neuropathy and without neuropathy (corneal nerve branch density: 95.83/mm2 for the controls vs 72.37/mm2 for patients with HIV; median difference, -24.53; 95.32%CI, -50.62 to -3.13; P = .01; and corneal nerve fiber length: 28.4 mm/mm2 for the controls vs 21.9 mm/mm2 for patients with HIV; median difference, -5.24; 95.09%CI, -8.83 to -1.38; P = .001). Tortuosity coefficient was increased in patients with HIV compared with controls (16.44 vs 13.95; median difference, 2.34; 95.09% CI, 0.31 to 4.65; P = .03) and in those with HIV-SN compared with those without (17.84 vs 14.18; median difference, 4.32; 95.92%CI, 0.68-9.23; P = .01). No differences were identified in corneal Langerhans cell density (19.84 cells/mm2 for the controls vs 41.43 cells/mm2 for patients with HIV; median difference, 9.38; 95%CI, -12.51 to 26.34; P = .53). CONCLUSIONS AND RELEVANCE: In vivo corneal confocal microscopy could be used in the assessment of HIV-SN, but larger studies are required to confirm this finding.

AB - IMPORTANCE: Objective quantification of small fiber neuropathy in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy (HIV-SN) is difficult but needed for diagnosis and monitoring. In vivo corneal confocal microscopy (IVCCM) can quantify small fiber damage. OBJECTIVE: To establish whether IVCCM can identify an abnormality in corneal nerve fibers and Langerhans cells in patients with and without HIV-SN. DESIGN, SETTING, AND PARTICIPANTS: This prospective, cross-sectional cohort studywas conducted between July 24, 2015, and September 17, 2015. Twenty patients whowere HIV positivewere recruited from adult outpatient clinics at Chelsea andWestminster Hospital NHS Foundation Trust in England. These patients underwent IVCCM at Moorfields Eye Hospital NHS Foundation Trust in London, England, and the IVCCM imageswere analyzed atWeill Cornell Medicine-Qatar in Ar-Rayyan, Qatar. Patientswere given a structured clinical examination and completed validated symptom questionnaires and the Clinical HIV-Associated Neuropathy Tool. Results from patients with HIVwere compared with the results of the age- and sex-matched healthy control participants (n = 20). All participantswere classified into 3 groups: controls, patients with HIV but without SN, and patients with HIV-SN. MAIN OUTCOMES AND MEASURES: Comparison of corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal nerve fiber tortuosity, and corneal Langerhans cell density between healthy controls and patients with HIV with and without SN. RESULTS: All 40 participants were male, and most (≥70%) self-identified as white. Of the 20 patients with HIV, 14 (70%) had HIV-SN. This group was older (mean [SD] age, 57.7 [7.75] years) than the group without HIV-SN (mean [SD] age, 42.3 [7.26] years) and the controls (mean [SD] age, 53.8 [10.5] years). Corneal nerve fiber density was reduced in patients with HIV compared with the controls (26.7/mm2 vs 38.6/mm2; median difference, -10.37; 95.09% CI, -14.27 to -6.25; P < .001) and in patients with HIV-SN compared with those without (25.8/mm2 vs 30.7/mm2; median difference, -4.53; 95.92%CI, -8.85 to -0.26; P = .03). Corneal nerve branch density and corneal nerve fiber length were reduced in patients with HIV, but no differences were identified between those with neuropathy and without neuropathy (corneal nerve branch density: 95.83/mm2 for the controls vs 72.37/mm2 for patients with HIV; median difference, -24.53; 95.32%CI, -50.62 to -3.13; P = .01; and corneal nerve fiber length: 28.4 mm/mm2 for the controls vs 21.9 mm/mm2 for patients with HIV; median difference, -5.24; 95.09%CI, -8.83 to -1.38; P = .001). Tortuosity coefficient was increased in patients with HIV compared with controls (16.44 vs 13.95; median difference, 2.34; 95.09% CI, 0.31 to 4.65; P = .03) and in those with HIV-SN compared with those without (17.84 vs 14.18; median difference, 4.32; 95.92%CI, 0.68-9.23; P = .01). No differences were identified in corneal Langerhans cell density (19.84 cells/mm2 for the controls vs 41.43 cells/mm2 for patients with HIV; median difference, 9.38; 95%CI, -12.51 to 26.34; P = .53). CONCLUSIONS AND RELEVANCE: In vivo corneal confocal microscopy could be used in the assessment of HIV-SN, but larger studies are required to confirm this finding.

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