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Neuromuscular and Myopathic Complications of HIV

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:

Mononeuropathy multiplex

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.

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