Neuromuscular diseases associated with human immunodeficiency virus infection

Abstract

The types of neuromuscular diseases associated with human immunodeficiency virus (HIV) infection are described. Our classification includes: (1) six subtypes of peripheral neuropathies--namely, acute Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, mononeuritis multiplex, an axonal, predominantly sensory, painful polyneuropathy, a sensory ataxic neuropathy due to ganglioneuronitis, and an inflammatory polyradiculoneuropathy presenting as cauda equina syndrome; (2) inflammatory myopathies (e.g., polymyositis); and (3) other less common neuromuscular manifestations, such as type II muscle fiber atrophy and nemaline myopathy. Although the exact incidence of clinical and subclinical neuromuscular diseases in HIV-positive and acquired immunodeficiency syndrome (AIDS) patients is unknown, estimates vary from 15 to almost 50% of such individuals. The type of neuropathy or myopathy related to the specific stage of HIV infection, the pathogenetic mechanisms involved, and effective therapies are discussed. A neuromuscular disease not only occurs in patients with AIDS and AIDS-related complex, but it can coincide with HIV seroconversion or it can be the only clinical indication of a chronic silent HIV infection. Chronic asymptomatic HIV infection should be considered in the differential diagnosis of certain acquired inflammatory polyneuropathies or myopathies. Precautions needed when doing electromyographic studies are discussed.

The frequency of peripheral neuropathy in a group of HIV positive patients in Brazil

“…It can be caused by the direct or indirect action of HIV and antibody production, or secondary to infections (CMV,MAC ), toxic effects of certain drugs (isoniazid, vincristine, d4T, ddi, ddC), or nutritional deficiencies (vitamin B12) 4,7,[22][23][24][25][26][34][35][36] . In our study, almost all the patients that had diagnosis of peripheral neuropathy were taking drugs probably neurotoxic (ddi, d4t,ddC isoniazid).…”

“…This specificity reflects the distinct mechanisms of the various types of peripheral neuropathies in HIV seropositive individuals [6][7][8][9][10][11] . The prevalence of peripheral neuropathy associated with HIV-1 is estimated at 15 to 50% of patients 7,[12][13][14][15] . But it may be almost 100% when a pathological study is performed 14,15 .…”

Episodes of Guillain-Barré syndrome associated with the acute phase of HIV-1 infection and with recurrence of viremia

“…The mechanisms proposed for GBS in HIV-1 -i n f e c ted patients include a direct action of HIV-1 on the n e rves by neuro t ropic strains, or of autoimmune mechanisms, with the formation of antibodies against myelin secondary to the abnormal immunore g u l ation determined by HIV infection 10 .…”

Miopatia nemalínica com corpos intracitoplasmáticos esferúides: relato de caso

“…A associação de bastões e corpos citoplasmáticos já foi descrita na miopatia pelo vírus da imunodeficiência humana tipo II (HIV) 6,7,21 . A característica principal e mais freqüente da miopatia pelo HIV é a necrose de fibras musculares isoladas com infiltrado inflamatório mononuclear, ocorrendo, em menor proporção, atrofia de fibras tipo II, corpos citoplasmáticos e/ou bastões.Atualmente acredita-se que a lesão muscular seja secundária a alterações imunitárias desencadeadas pelo vírus e não à ação direta do vírus sobre a fibra muscular.…”