Chapter 4 : HIV-Associated Myelopathy, Myopathy, and Meningitis

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This chapter discusses the complications arising from involvement of the meninges, spinal cord, and muscles by the virus. Clinical features, diagnostic tests, and management of HIV-associated myelopathy, myopathy, and meningitis are discussed. The incidence of clinical HIV-associated myopathy has not been established in prospective studies, although on the whole it appears to be relatively uncommon. In contrast, electromyography is sensitive and specific in the diagnosis of myopathy. Early reports described two histological patterns of HIV-associated myopathy prior to the availability of antiretroviral agents. The percentage of ragged red fibers was reported to be correlated with the severity of clinical myopathy. The conclusion was that mitochondrial abnormalities were not specific to ZDV-associated myopathy. Corticosteroids may provide benefit in HIV-associated myopathy. While intravenous immunoglobulins may be an alternative option without risk of immunosuppression, there is only limited reported experience with their use in HIV-associated myopathy. Spinal cord dysfunction, muscle disease, and meningitis may occur associated with HIV infection. The precise pathogenic mechanisms are unclear, but in myelopathy and myopathy, indirect mechanisms are believed to be responsible. In HIV-associated myelopathy, symptomatic treatment is the mainstay of management. Corticosteroids and intravenous immunoglobulin therapy are used for the treatment of HIV-associated myopathy; the initiation of HAART without myotoxic agents may also provide benefit in those who are untreated.

Citation: Estanislao L. 2009. HIV-Associated Myelopathy, Myopathy, and Meningitis, p 57-63. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch4
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Image of FIGURE 1.

Axial and sagittal T2-weighted MRI images of the spinal cord showing increased T2 signal in the posterior columns.

Citation: Estanislao L. 2009. HIV-Associated Myelopathy, Myopathy, and Meningitis, p 57-63. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch4
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1. Artigas, J.,, G. Grosse, and, F. Niedobitek. 1990. Vacuolar myelopathy in AIDS: a morphological analysis. Pathol. Res. Pract. 186: 228237.
2. Berman, A.,, L. R. Espinoza,, J. D. Diaz,, J. L. Aguilar,, T. Rolando,, F. B. Vasey,, B. F. Germain, and, R. F. Lockey. 1988. Rheumatic manifestations of human immunodeficiency virus infection. Am. J. Med. 85: 5964.
3. Bessen, L. J.,, J. B. Greene,, E. Louie,, P. Seitzman, and, H. Weinberg. 1988. Severe polymyositis-like syndrome associated with zidovudine therapy of AIDS and ARC. N. Engl. J. Med. 318: 708. (Letter.)
4. Breton, G.,, X. Duval,, A. Gervais,, P. Longuet,, C. Leport, and, J. L. Vilde. 2003. Retroviral rebound syndrome with meningoencephalitis after cessation of antiretroviral therapy. Am. J. Med. 114: 769770.
5. Budka, H. 1990. Human immunodeficiency virus (HIV) envelope and core proteins in CNS tissues of patients with the acquired immune deficiency syndrome (AIDS). Acta Neuropathol. 79: 611619.
6. Castagna, A.,, C. Le Grazie,, A. Accordini,, P. Giulidori,, G. Cavalli,, T. Bottiglieri, and, A. Lazzarin. 1995. Cerebrospinal fluid S-adenosylmethionine (SAMe) and glutathione concentrations in HIV infection: effect of parenteral treatment with SAMe. Neurology 45: 16781683.
7. Chalmers, A. C.,, C. M. Greco, and, R. G. Miller. 1991. Prognosis in AZT myopathy. Neurology 41: 11811184.
8. Chariot, P.,, E. Ruet,, F. Authier,, Y. Levy, and, R. Gherardi. 1994. Acute rhabdomyolysis in patients infected with human immunodeficiency virus. Neurology 44: 16921696.
9. Chong, J.,, A. Di Rocco,, M. Tagliati,, F. Danisi,, D. M. Simpson, and, S. W. Atlas. 1999. MR findings in AIDS-associated myelopathy. Am. J. Neuroradiol. 20: 14121416.
10. Dalakas, M. C.,, I. Illa,, G. H. Pezeshkpour,, J. P. Laukaitis,, B. Cohen, and, J. L. Griffin. 1990. Mitochondrial myopathy caused by long-term zidovudine therapy. N. Engl. J. Med. 322: 10981105.
11. Dalakas, M.,, G. Pezeshkpour,, M. Gravell, and, J. Sever. 1986. Polymyositis associated with AIDS retrovirus. JAMA 256: 23812383.
12. Dal Pan, G.,, and J. Berger. 1997. Spinal cord disease in human immunodeficiency virus infection, p. 173–187. In J. Berger and, R. Levy (ed.), AIDS and the Nervous System. Lippincott-Raven, Philadelphia, PA.
13. Dal Pan, G. J.,, J. D. Glass, and, J. C. McArthur. 1994. Clinicopathologic correlations of HIV-1-associated vacuolar myelopathy: an autopsy-based case-control study. Neurology 44: 21592164.
14. de Sanctis, J. T.,, G. Cumbo-Nacheli,, D. Dobbie, and, D. Baumgartner. 2008. HIV-associated nemaline rod myopathy: role of intravenous immunoglobulin therapy in two persons with HIV/AIDS. AIDS Reader 18: 9094.
15. Di Rocco, A.,, P. Werner,, T. Bottiglieri,, J. Godbold,, M. Liu,, M. Tagliati,, A. Scarano, and, D. Simpson. 2004. Treatment of AIDS-associated myelopathy with l-methionine: a placebo-controlled study. Neurology 63: 12701275.
16. Di Rocco, A.,, T. Bottiglieri,, P. Werner,, A. Geraci,, D. Simpson,, J. Godbold, and, S. Morgello. 2002. Abnormal cobalamin-dependent transmethylation in AIDS-associated myelopathy. Neurology 58: 730735.
17. Di Rocco, A.,, A. Geraci, and, M. Tagliati. 2000. Remission of HIV myelopathy after highly active antiretroviral therapy. Neurology 55: 456. (Letter.)
18. Di Rocco, A. 1999. Diseases of the spinal cord in human immunodeficiency virus infection. Semin. Neurol. 19: 151155.
19. Di Rocco, A.,, M. Tagliati,, F. Danisi,, D. Dorfman,, J. Moise, and, D. Simpson. 1998. l-Methionine for AIDS-associated vacuolar myelopathy. Neurology 51: 266268.
20. Dorfman, D.,, A. DiRocco,, D. Simpson,, M. Tagliati,, L. Tanners, and, J. Moise. 1997. Oral methionine may improve neuropsychological function in patients with AIDS myelopathy: results of an open-label trial. AIDS 11: 10661067.
21. Eilbott, D.,, N. Peress,, H. Burger,, D. LaNeve,, J. Orenstein,, H. E. Gendelman,, R. Seidman, and, B. Weiser. 1989. Human immunodeficiency virus type 1 in spinal cords of acquired immunodeficiency syndrome patients with myelopathy: expression and replication in macrophages. Proc. Natl. Acad. Sci. USA 86: 33373341.
22. Espinoza, L. R.,, J. L. Aguilar,, C. G. Espinoza,, J. Gresh,, J. Jara,, L. H. Silveira,, P. Martinez-Osuna, and, M. Seleznick. 1991. Characteristics and pathogenesis of myositis in human immunodeficiency virus infection. Distinction from azidothymidine-induced myopathy. Rheum. Dis. Clin. N. Am. 107: 598599.
23. Geraci, A.,, and A. Di Rocco. 2000. Anti-HIV therapy. AIDS 14: 20592061.
24. Geraci, A.,, A. Di Rocco,, M. Liu,, P. Werner,, M. Tagliati,, J. Godbold,, D. Simpson, and, S. Morgello. 2000. AIDS myelopathy is not associated with elevated HIV viral load in cerebrospinal fluid. Neurology 55: 440442.
25. Gertner, E.,, J. Thurn,, D. N. Williams,, M. Simpson,, H. H. Balfour, Jr.,, F. Rhame, and, K. Henry. 1989. Zidovudine-associated myopathy. Am. J. Med. 6: 814818.
26. Goldstick, L.,, T. Mandybur, and, R. Bode. 1985. Spinal cord degeneration in AIDS. Neurology 35: 103106.
27. Gonzales, M. F.,, R. K. Olney,, Y. T. So,, C. M. Greco,, B. A. McQuinn,, R. G. Miller, and, S. J. DeArmond. 1988. Subacute structural myopathy associated with human immunodeficiency virus infection. Arch. Neurol. 45: 585587.
28. Gorard, D. A.,, K. Henry,, R. Guiloff,, P. K. Panegyres,, N. Tan,, B. A. Kakulas,, J. A. Armstrong, and, P. Hollingsworth. 1988. Necrotizing myopathy and zidovudine. Lancet 331: 10501051.
29. Helbert, M.,, T. Fletcher,, B. Peddle,, J. R. Harris, and, A. J. Pinching. 1988. Zidovudine-associated myopathy. Lancet 332: 689690.
30. Ilia, I.,, A. Nath, and, M. Dalakas. 1991. Immunocytochemical and virological characteristics of HIV-associated inflammatory myopathies: similarities with seronegative patients. Ann. Neurol. 29: 474481.
31. Jakobsen, J.,, T. Smith,, J. Gaub,, S. Helweg-Larsen, and, W. Trojaborg. 1989. Progressive neurological dysfunction during latent HIV infection. Br. Med. J. 299: 225228.
32. Kahn, J. O.,, and B. D. Walker. 1998. Acute human immunodeficiency virus type 1 infection. N. Engl. J. Med. 339: 3339.
33. Kieburtz, K.,, D. Giang,, R. Schiffer, and, N. Vakil. 1991. Abnormal vitamin B 12 metabolism in human immunodeficiency virus infection: association with neurologic dysfunction. Arch. Neurol. 48: 312314.
34. Kure, K.,, J. Llena,, W. Lyman,, R. Soreiro,, K. Weidenheim,, A. Hirano, and, D. Dickson. 1991. Human immunodeficiency virus-1 infection of the nervous system: an autopsy study of 268 adult, pediatric and fetal brains. Hum. Pathol. 22: 700710.
35. Lang, W.,, J. Miklossy,, J. Deruaz,, G. Pizzolato,, A. Probst,, T. Schaffner,, E. Gessaga, and, E. Kleihues. 1989. Neuropathology of the acquired immunodeficiency syndrome: a report of 135 consecutive autopsy cases from Switzerland. Acta Neuropathol. 77: 379390.
36. Manji, H.,, M. J. Harrison,, J. M. Round,, D. A. Jones,, S. Connolly,, C. J. Fowler,, I. Williams, and, I. V. Weller. 1993. Muscle disease, HIV and zidovudine: the spectrum of muscle disease in HIV-infected individuals treated with zidovudine. J. Neurol. 240: 479488.
37. Marshall, D. W.,, R. L. Brew,, W. T. Cahill,, R. W. Houk,, R. A. Zajac, and, R. N. Boswell. 1988. Spectrum of cerebrospinal fluid findings in various stages of human immunodeficiency virus infection. Arch. Neurol. 45: 954958.
38. McArthur, J. C.,, B. A. Cohen,, H. Farzedegan,, D. R. Cornblath,, O. A. Selnes,, D. Ostrow,, R. T. Johnson,, J. Phair, and, B. F. Polk. 1988. Cerebrospinal fluid abnormalities in homosexual men with and without neuropsychiatric findings. Ann. Neurol. 23 (Suppl): S34S37.
39. Mhiri, C.,, M. Baudrimont,, G. Bonne,, C. Geny,, F. Degoul,, C. Marsac,, E. Roullet, and, R. Gherardi. 1991. Zidovudine myopathy: a distinctive disorder associated with mitochondrial dysfunction. Ann. Neurol. 29: 606614.
40. Miller, K. D.,, M. Cameron,, L. V. Wood,, M. C. Dalakas, and, J. A. Kovacs. 2000. Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases. Ann. Intern. Med. 133: 192196.
41. Misra, U. K.,, and J. Kalita. 2007. Comparison of clinical and electrodiagnostic features in B 12 deficiency neurological syndromes with and without antiparietal cell antibodies. Postgrad. Med. J. 83: 124127.
42. Mokrzycki, M. H.,, C. Harris,, H. May,, J. Laut, and, J. Palmisano. 2000. Lactic acidosis associated with stavudine administration: a report of five cases. Clin. Infect. Dis. 30: 198200.
43. Morgello, S.,, D. Wolfe,, E. Godfrey,, R. Feinstein,, M. Tagliati, and, D. M. Simpson. 1995. Mitochondrial abnormalities in human immunodeficiency virus-associated myopathy. Acta Neuropathol. 90: 366374.
44. Oksenhendler, E.,, F. Ferchal,, J. Cadranel,, H. Sauvageon-Martre, and, J. Clauvel. 1990. Zidovudine for HIV-related myelopathy. Am. J. Med. 88: 6566.
45. Panegyres, P. K.,, J. M. Papadimitriou,, P. N. Hollingsworth,, J. A. Armstrong, and, B. A. Kakulas. 1990. Vesicular changes in the myopathies of AIDS. Ultrastructural observations and their relationship to zidovudine treatment. J. Neurol. Neurosurg. Psychiatry 53: 649655.
46. Petito, C. K.,, D. Vecchio, and, Y. T. Chen. 1994. HIV antigen and DNA in AIDS spinal cords correlate with macrophage infiltration but not with vacuolar myelopathy. J. Neuropathol. Exp. Neurol. 53: 8694.
47. Petito, C. K.,, B. A. Navia,, E. S. Cho,, B. D. Jordan,, D. C. George, and, R. W. Price. 1985. Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with the acquired immunodeficiency syndrome. N. Engl. J. Med. 312: 874879.
48. Pierelli, F.,, C. Garrubba,, G. Tilia,, L. Parisi,, F. Fattapposta,, G. Pozzessere,, G. Soldati,, P. Stanzione,, G. D’Offizi, and, I. Mezzaroma. 1996. Multimodal evoked potentials in HIV-1-seropositive patients: relationship between the immune impairment and the neurophysiological function. Acta Neurol. Scand. 93: 266271.
49. Rosenblum, M.,, A. C. Scheck,, K. Cronin,, B. J. Brew,, A. Khan,, M. Paul, and, R. W. Price. 1989. Dissociation of AIDS-related vacuolar myelopathy and productive HIV-1 infection of the spinal cord. Neurology 39: 892896.
50. Seidman, R.,, N. Peress, and, G. Nuovo. 1994. In situ detection of polymerase chain reaction-amplified HIV-1 nucleic acids in skeletal muscle in patients with myopathy. Mod. Pathol. 7: 369375.
51. Simpson, D. M.,, P. Slasor,, U. Dafni,, J. Berger,, M. A. Fischl, and, C. Hall. 1997. Analysis of myopathy in a placebo-controlled zidovudine trial. Muscle Nerve 20: 382385.
52. Simpson, D.,, and M. Tagliati. 1994. Neurological manifestations of HIV infection. Ann. Intern. Med. 121: 769785.
53. Simpson, D. M.,, K. A. Citak,, E. Godfrey,, J. Godbold, and, D. E. Wolfe. 1993. Myopathies associated with human immunodeficiency virus and zidovudine: can their effects be distinguished? Neurology 43: 971976.
54. Simpson, D. M.,, and A. N. Bender. 1988. Human immunodeficiency virus-associated myopathy: analysis of 11 patients. Ann. Neurol. 24: 7984.
55. Snider, W.,, D. M. Simpson,, S. Nielsen,, C. Metroka, and, J. Posner. 1983. Neurological complications of acquired immunodeficiency syndrome: analysis of 50 patients. Ann. Neurol. 14: 403418.
56. Staudinger, R.,, and K. Henry. 2000. Remission of HIV myelopathy after highly active antiretroviral therapy. Neurology 54: 267268.
57. Surtees, R.,, K. Hyland, and, I. Smith. 1990. Central nervous system methyl group metabolism in children with neurological complications of HIV infection. Lancet 335: 619621.
58. Tagliati, M.,, A. Di Rocco,, F. Danisi, and, D. Simpson. 2000. The role of somatosensory evoked potentials in the diagnosis of AIDS-associated myelopathy. Neurology 54: 14771482.
59. Tan, S.,, R. Guiloff, and, F. Scaravilli. 1995. AIDS-associated vacuolar myelopathy. A morphometric study. Brain 118: 12471261.
60. Tan, S. V.,, and R. J. Guiloff. 1998. Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J. Neurol. Neurosurg. Psychiatry 65: 2328.
61. Till, M.,, and K. MacDonnell. 1991. Myopathy with human immunodeficiency virus type 1 (HIV-1) infection: HIV-1 or zidovudine. Ann. Intern. Med. 113: 492494.
62. Wendel, K.,, and J. McArthur. 2003. Acute meningoencephalitis in chronic human immunodeficiency virus (HIV) infection: putative central nervous system escape of HIV replication. Clin. Infect. Dis. 37: 11071111.
63. Yarchoan, R.,, P. Brouwers,, A. R. Spitzer,, J. Grafman,, B. Safai,, C. F. Perno,, S. M. Larson,, G. Berg,, M. A. Fischl,, A. Wichman,, R. V. Thomas,, A. Brunetti,, P. J. Schmidt,, C. E. Myers, and, S. Broder. 1987. Response of immunodeficiency virus-associated neurological disease to 3′-azido-3′ deoxythymidine. Lancet 329: 132135.

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