Overview
HIV-infected patients are susceptible to a wide spectrum of HIV-associated neuromuscular and myopathic conditions.
Of course, patients also are susceptible to the same neuromuscular diseases as the general public (eg, carpal tunnel syndrome in an HIV-positive barber or computer operator). However, since the introduction of highly active antiretroviral therapy (HAART), HIV-associated neurologic complications have decreased markedly.
Neuromuscular conditions associated with HIV infection include the following:
Acute or chronic inflammatory demyelinating polyradiculoneuropathy
Distal, symmetric, often painful, and predominantly sensory polyneuropathy
Autonomic neuropathy (eg, erectile dysfunction)
Antiretroviral-associated (eg, zidovudine) neuropathy
Polyradiculopathy
HIV myopathy
Polymyositis and dermatomyositis
Inclusion body myositis
Nemaline (rod) myopathy
Pyomyositis
Neuropathies associated with diffuse infiltrative lymphocytosis syndrome (DILS)
Myopathy caused by local neoplasm
Myopathy caused by local infection
Myasthenic syndrome and chronic fatigue
Medication-induced myopathy (e.g., zidovudine)
HIV wasting syndrome
Asymptomatic elevations in CK, myaglias, and rhabdomyolysis are all possible complications of HIV. Particular types of myopathies reflect the clinical status of the patient and the stage of HIV disease.
For example, nonspecific myalgias occur as part of the flulike illness during seroconversion. Treated patients may develop inflammatory myopathy related to immune restoration or drug-induced muscle involvement. HIV wasting syndrome and opportunistic muscle infections are encountered in untreated patients with advanced disease.