eMedicine Specialties > Neurology > Neurological Infections

HIV-1 Associated Neuromuscular Complications (Overview): Differential Diagnoses & Workup

Author: Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Coauthor(s): Niranjan N Singh, MD, DNB, Assistant Professor of Neurology, University of Missouri Columbia
Contributor Information and Disclosures

Updated: Jun 29, 2009

Differential Diagnoses

Acute Inflammatory Demyelinating Polyradiculoneuropathy
HIV-1 Associated Multiple Mononeuropathies
Cauda Equina and Conus Medullaris Syndromes
HIV-1 Associated Myopathies
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
HIV-1 Associated Progressive Polyradiculopathy
Dermatomyositis/Polymyositis
HIV-1 Associated Vacuolar Myelopathy
Diabetic Neuropathy
Guillain-Barre Syndrome in Childhood
HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy

Workup

Laboratory Studies

Laboratory studies depend on the type of neuromuscular complication that is suspected. A full neuropathy workup for suspected neuropathies, or myopathy workup for suspected myopathies, and can be found in eMedicine Neurology for each specific disorder. Typically, the workup includes serum laboratory testing, CSF examination, EMG/NCSs, and possible nerve and/or muscle biopsy.

See HIV-1 Associated Acute/Chronic Inflammatory Demyelinating Polyradiculoneuropathy, HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy, HIV-1 Associated Multiple Mononeuropathies, HIV-1 Associated Myopathies, and HIV-1 Associated Progressive Polyradiculopathy.

Histologic Findings

HIV RNA and/or the virus have been detected in nerve and dorsal root ganglia. Infected cells include satellite and mononuclear cells and occasional dorsal root ganglion neurons. In the skin, epidermal nerve fiber densities are reduced in symptomatic and asymptomatic distal HIV polyneuropathy compared with controls.

More on HIV-1 Associated Neuromuscular Complications (Overview)

Overview: HIV-1 Associated Neuromuscular Complications (Overview)
Differential Diagnoses & Workup: HIV-1 Associated Neuromuscular Complications (Overview)
Treatment & Medication: HIV-1 Associated Neuromuscular Complications (Overview)
Follow-up: HIV-1 Associated Neuromuscular Complications (Overview)
References
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References

  1. Dalakas MC, Semino-Mora C, Leon-Monzon M. Mitochondrial alterations with mitochondrial DNA depletion in the nerves of AIDS patients with peripheral neuropathy induced by 2'3'-dideoxycytidine (ddC). Lab Invest. 2001;81:1537-1544. [Medline].

  2. Ferrari S, Vento S, Monaco S, Cavallaro T, Cainelli F, Rizzuto N, et al. Human immunodeficiency virus-associated peripheral neuropathies. Mayo Clin Proc. Feb 2006;81(2):213-9. [Medline].

  3. Maschke M, Kastrup O, Esser S, et al. Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry. Sep 2000;69(3):376-80. [Medline].

  4. Chariot P, Gherardi R. Myopathy and HIV infection. Curr Opin Rheumatol. Nov 1995;7(6):497-502. [Medline].

  5. Neuromuscular Disorders in HIV-1 Infection. In: Mancall E, ed. Continuum. 6 number 5 Part A. Lippincott Williams & Wilkins; 2000:73-79.

  6. de Gans J, Portegies P. Neurological complications of infection with human immunodeficiency virus type 1. A review of literature and 241 cases. Clin Neurol Neurosurg. 1989;91(3):199-219. [Medline].

  7. Gendelman HE, Lipton SA, Epstein L. The Neurology of AIDS. New York: Chapman & Hall; 1998.

  8. Herrmann DN, McDermott MP, Henderson D. Epidermal nerve fiber density, axonal swellings and QST as predictors of HIV distal sensory neuropathy. Muscle & Nerve. 2004;29:420-427. [Medline].

  9. Luciano CA, Pardo CA, McArthur JC. Recent developments in the HIV neuropathies. Curr Opin Neurol. Jun 2003;16(3):403-9. [Medline].

  10. Said G, Saimont AG, Lacroix C. Neurological Complications of HIV and AIDS. Philadelphia, Pa: WB Saunders; 1998.

  11. Simpson DM, Olney RK. Peripheral neuropathies associated with human immunodeficiency virus infection. Neurol Clin. Aug 1992;10(3):685-711. [Medline].

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Further Reading

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Keywords

acquired immunodeficiency syndrome, AIDS, HIV-related neuromuscular disease, mononeuropathy multiplex, acute inflammatory demyelinating polyradiculoneuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, sensory polyneuropathy, autonomic neuropathy, polyradiculopathy, inflammatory myopathy, noninflammatory myopathy, drug toxicity, lymphoma, polymyositis, toxoplasmosis, bacterial infections, nonspecific myalgias, cytomegalovirus, CMV, herpes simplex virus infection, varicella zoster virus, Mycobacterium avium-intracellulare, Treponema pallidum, Guillain-Barré syndrome

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Contributor Information and Disclosures

Author

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Coauthor(s)

Niranjan N Singh, MD, DNB, Assistant Professor of Neurology, University of Missouri Columbia
Niranjan N Singh, MD, DNB is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Glenn Lopate, MD, Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Chief of Neurology, St Louis ConnectCare, Consulting Staff, Barnes Jewish Hospital
Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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