ALS-Like Disorder in Three HIV-Positive Patients: Case Series

Abstract

There appears to be a relationship between retroviruses such as HIV and the development of an ALS-like syndrome. Few cases have been reported; however, there exists evidence of a higher frequency of motor neuron disease in HIV-infected patients, as well as potential slowing and reversibility of disease course with combination antiretroviral therapy. We conducted a retrospective chart review of patients presenting to the George Washington University ALS Clinic from September 2006 to June 2018 to identify patients with HIV receiving HAART who were subsequently diagnosed with ALS or an ALS-like disorder. Our goals were to describe our patients’ disease course and compare them to general characteristics of ALS. We report three cases of HIV-positive individuals, all male, who were subsequently diagnosed with ALS. Each presented with symptoms of limb onset ALS with involvement of upper and lower motor neurons and whose disease originated at the cervical level. All three had been diagnosed with HIV prior to presentation and were presumably compliant with antiretroviral therapy throughout. Our patients demonstrated effective control of their HIV infection. Each experienced relatively slow progression of motor impairment compared to general ALS characteristics. Our study offers a distinct profile of HIV-positive patients compliant with HAART subsequently diagnosed with an ALS-like disorder. Further study should aim to uncover pathophysiological similarities between motor neuron disease both in the presence and absence of retroviral infection and to develop effective medical therapy for each.

Etiological profile of peripheral neuropathies in an academic hospital in southern Morocco

“…The majority of cases in this study were of primary origin with only 5 cases imputed to syphilis. HIV-associated ALS has also been reported in other series [ 36 ].…”

Juvenile amyotrophic lateral sclerosis in 16 years old girl with HIV

“…While many studies have reported the beneficial clinical effect of ARV therapy on a patient's outcome, her weakness progressed after one year of ARV therapy. However, a case report study by Satin et al, demonstrated three patients with HIV-associated ALS with mixed UMN and LMN involvement and slow disease progression with proper clinical response to ARV therapy (6). Unlike clinical response in our patient, MacGowan et al, reported a 32-year-old woman with HIVassociated ALS who recovered from motor neuron deficit after initiation of ARV therapy (7).…”

Three ALS genes regulate expression of the MHC class II antigen presentation pathway

“…Previous studies of HIV patients shed further light on the importance of the systemic immune system in ALS. These studies reported that HIV patients are more likely to exhibit an ALS-like syndrome, and this condition improves after anti-HIV treatment (Satin and Bayat 2021; Bowen et al 2016; MacGowan et al 2001; Quevedo-Ramirez et al 2020; Verma and Berger 2006). Relative to the studies of motor neurons and glial cells in ALS, much less work has been done on the systemic aspect of ALS.…”