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Am J Emerg Med 2016 Apr 29;34(4):760.e3-5. Epub 2015 Aug 29.

Mercer University School of Medicine, Macon, GA.

Acute rhabdomyolysis is a rare phenomenon in the emergency setting almost exclusively associated with trauma, drugs, and recent upper respiratory and gastrointestinal infection. Rare reports in the literature have highlighted adult patients presenting with rhabdomyolysis as 1 component in a constellation of symptoms in acute HIV-1 seroconversion; however, there are few reports of rhabdomyolysis as the sole presenting symptom. This case highlights the importance of investigating HIV and other sexually transmitted diseases in pediatric cases of rhabdomyolysis in the emergency care setting. Read More

AIDS Res Hum Retroviruses 2014 Dec;30(12):1162-9

Department of Medical and Surgical Sciences, Infectious Diseases Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna , Bologna, Italy .

To evaluate the frequency of myopathy and serum creatine kinase (CK) elevation associated with the use of the integrase inhibitor raltegravir we conducted a retrospective, cohort analysis assessing the incidence of skeletal muscle toxicity among HIV-infected patients treated with raltegravir. Adult HIV-infected patients who started a raltegravir-containing therapy were enrolled into the study. The skeletal muscle toxicity was defined by the presence of one or more of the following parameters: (1) isolated and significant CK elevation without signs or symptoms; (2) diffuse myalgia without weakness; (3) proximal muscle weakness; (4) rhabdomyolysis. Read More

Braz J Infect Dis 2015 Jan-Feb;19(1):1-7. Epub 2014 Sep 16.

Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Serra Gaucha College, Caxias do Sul, Brazil. Electronic address:

Background: the impact of human immunodeficiency virus type 1 (HIV-1) on lung function is well known and associated with a reduction in pulmonary ventilation. Moreover, the use of highly active antiretroviral therapy has been associated with mitochondrial dysfunction and decreased muscle strength. However, there is scarce information about the factors associated with inspiratory muscle weakness in these patients. Read More

HIV Med 2014 Jan 6;15(1):40-9. Epub 2013 Sep 6.

Infectious Diseases Department, University Hospital Ramón y Cajal, Madrid, Spain; Health Research Institute Ramón y Cajal (IRYCIS), Madrid, Spain.

Objectives: Inversion of the CD4:CD8 ratio (< 1) has been identified as a hallmark of inmmunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD4:CD8 ratio and markers of age-associated disease in treated HIV-infected patients with good immunovirological response.

Methods: A cross-sectional analysis was conducted in 132 HIV-infected adults on antiretroviral therapy (ART), with plasma HIV RNA < 50 HIV-1 RNA copies/mL for at least 1 year, CD4 count > 350 cells/μL and age < 65 years. Read More

J Acquir Immune Defic Syndr 2013 Apr;62(5):525-33

Clinical Research Program, St. Vincent's Centre for Applied Medical Research, Sydney, Australia.

Objective/design: Raltegravir is uncommonly associated with rhabdomyolysis and grade 3-4 creatine kinase (CK) elevation. In this cross-sectional study, we compared the prevalence of skeletal muscle toxicity in HIV-infected adults receiving raltegravir with that of a control group.

Methods: Adults receiving combination antiretroviral therapy were recruited consecutively. Read More

West Indian Med J 2013 ;62(4):377-9

Institute of Infectious Diseases and Public Health, Universita Politecnica delle Marche, Ancona, Italy.

Sustained increase of serum creatine phosphokinase (CPK) concentrations and muscle abnormalities have been reported in patients taking raltegravir (RAL). In this report, we describe a case of sustained and asymptomatic increase of serum CPK concentrations associated with raltegravir, zidovudine, and lamivudine in an HIV-1 experienced patient with intolerance to protease inhibitor, abacavir and penicillin during 32 weeks of continuous drug monitoring. Read More

Afr Health Sci 2012 Mar;12(1):74-6

Department of Medicine, Niger Delta University, Wilberforce Island, Amasomma, Bayelsa State, Nigeria.

Human immunodeficiency virus (HIV) infection has been implicated as a trigger for various autoimmune diseases, one of which is dermatomyositis. This is a very rare autoimmune disease characterised by myopathy, typical cutaneous signs and variable systemic manifestations. To our knowledge, the association of this rare disease with HIV infection has not been previously reported in Nigeria. Read More

HIV Med 2013 Apr 23;14(4):247-51. Epub 2012 Sep 23.

Department of Infection and Tropical Medicine, Royal Victo, ria Infirmary, Newcastle-upon-Tyne, UK.

Objective: The aim of the study was to determine the prevalence and risk factors for HIV-associated fatigue in the era of highly active antiretroviral therapy (HAART).

Methods: A cross-sectional survey of 100 stable HIV-infected out-patients was carried out. Severity of fatigue was measured using the Fatigue Impact Scale (FIS). Read More

AIDS Res Hum Retroviruses 2012 Sep 21;28(9):1089-94. Epub 2012 Feb 21.

Infectious Diseases Department, Hospital Carlos III, Madrid, Spain.

Human infection with the xenotropic murine leukemia virus-related virus (XMRV) has been associated controversially with prostate cancer and chronic fatigue syndrome. Information is lacking about the mechanisms of transmission and potential risk groups for XMRV infection. Plasma and peripheral blood mononuclear cells (PBMCs) from individuals with retroviral infections, chronic viral hepatitis, autoimmune diseases, prostate cancer, chronic fatigue syndrome, and blood donors were tested for XMRV markers. Read More

AIDS Res Ther 2011 Aug 16;8:30. Epub 2011 Aug 16.

Department of Medicine, Emory University School of Medicine, 615 Michael Street, Atlanta, GA 30322, USA.

Background: Separately, chronic alcohol ingestion and HIV-1 infection are associated with severe skeletal muscle derangements, including atrophy and wasting, weakness, and fatigue. One prospective cohort study reported that 41% of HIV-infected patients met the criteria for alcoholism, however; few reports exist on the co-morbid effects of these two disease processes on skeletal muscle homeostasis. Thus, we analyzed the atrophic effects of chronic alcohol ingestion in HIV-1 transgenic rats and identified alterations to several catabolic and anabolic factors. Read More

AIDS 2010 Apr;24(7):1088-90

AIDS 2010 Jan;24(3):473-5

Joint Bone Spine 2009 Oct 11;76(5):550-2. Epub 2009 Jun 11.

Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, AP-HP, Paris, France.

An immune reconstitution syndrome (IRS) occurs in between 10% and 25% of patients starting highly active antiretroviral treatment (HAART). A 49-year-old patient presents a tenosynovitis 6 weeks after HAART initiation. In our patient, exhaustive tests for infectious, inflammatory and drug-related causes of tenosynovitis were negative. Read More

Am J Physiol Endocrinol Metab 2008 Oct 19;295(4):E964-73. Epub 2008 Aug 19.

Department of Cellular and Molecular Physiology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.

The mechanism by which human immunodeficiency virus (HIV)-1 infection in humans leads to the erosion of lean body mass is poorly defined. Therefore, the purpose of the present study was to determine whether transgenic (Tg) rats that constitutively overexpress HIV-1 viral proteins exhibit muscle wasting and to elucidate putative mechanisms. Over 7 mo, Tg rats gained less body weight than pair-fed controls exclusively as a result of a proportional reduction in lean, not fat, mass. Read More

AIDS Res Ther 2008 Apr 25;5. Epub 2008 Apr 25.

Pulmonary, Allergy and Critical Care Medicine, Atlanta VA Medical Center and Emory University School of Medicine, 1670 Clairmont Road, Decatur, GA 30033, USA.

Background: Human immunodeficiency virus type 1 (HIV-1) infection and the consequent acquired immunodeficiency syndrome (AIDS) has protean manifestations, including muscle wasting and cardiomyopathy, which contribute to its high morbidity. The pathogenesis of these myopathies remains partially understood, and may include nutritional deficiencies, biochemical abnormalities, inflammation, and other mechanisms due to viral infection and replication. Growing evidence has suggested that HIV-1-related proteins expressed by the host in response to viral infection, including Tat and gp120, may also be involved in the pathophysiology of AIDS, particularly in cells or tissues that are not directly infected with HIV-1. Read More

Expert Opin Ther Targets 2007 Jun;11(6):835-51

Istituto Pasteur-Fondazione Cenci Bolognetti, Dipartimento di Studi Farmaceutici, Università di Roma La Sapienza, Piazzale Aldo Moro 5, I-00185 Roma, Italy.

In contrast to genetic aberrations, epigenetic aberrations can be reversed by the use of histone acetyltransferase (HAT), histone deacetylase (HDAC), SIRT, or histone methyltransferase (HMT) inhibitors. A well-known HDACi, suberoylanilide hydroxamic acid, has been recently approved for the treatment of cutaneous T cell lymphoma, and a number of HDACi are in clinical trials as anticancer drugs. In addition, HDACi could be useful in antimalarial and antifungal therapies and can reactivate the HIV-1 expression in latent cellular reservoirs, thus suggesting the use in a combination therapy with highly active antiretroviral therapy. Read More

Rev Med Interne 2007 May 29;28(5):322-5. Epub 2007 Jan 29.

Service de médecine interne et maladies infectieuses, hôpital Clermont-tonnerre, 29240 Brest, France.

Introduction: Acute human immunodeficiency virus type 1 infection is a clinical and biological misleading and often undiagnosed illness. Laboratory studies frequently demonstrate abnormalities. Acute rhabdomyolysis is rarely reported. Read More

Int J STD AIDS 2006 Jan;17(1):61-2

Worcestershire HIV Clinic, Worcestershire Acute Hospitals NHS Trust, Worcestershire Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK.

Creatine phosphokinase (CPK) estimations are done routinely in some HIV clinics, irrespective of patient symptoms. We studied patients attending the Worcestershire HIV clinic between 1987 and 2001 to identify whether routine elevations in serum levels of CPK in patients with HIV were associated with clinical features of muscle disease (CFMD), and whether such elevations influenced patient management. There was no association between CFMD and a rise in CPK. Read More

Mitochondrion 2004 Jul;4(2-3):169-73

Hawaii AIDS Clinical Research Program, John A Burns School of Medicine, University of Hawaii at Manoa, 3675 Kilauea Avenue, Young Building 5th Floor, Leahi Hospital, Honolulu, HI 96816, USA.

We describe a 50-year-old Caucasian man with a family history of myoclonic epilepsy associated with ragged red fibers (MERRF) and a diagnosis of Human Immunodeficiency Virus (HIV). The patient had multiple risk factors for contracting HIV and was being followed in our clinic at the time of his diagnosis. Initial testing following seroconversion revealed a baseline CD4+ T-lymphocyte count of 652 x 10(6)cells/l and a HIV-1 RNA of 14,781 copies/ml. Read More

Enferm Infecc Microbiol Clin 2004 Oct;22(8):503-4

AIDS 2004 Jul;18(10):1403-12

Objective: To investigate progressive, severe neuromuscular weakness associated with lactic acidosis in some HIV-infected patients after exposure to nucleoside reverse transcriptase inhibitors (NRTI).

Methods: HIV-associated neuromuscular weakness syndrome (HANWS) was retrospectively identified and classified based on the level of diagnostic certainty: possible (progressive weakness owing to neuromuscular disease), probable (progressive neuromuscular weakness with documented exclusion of confounding causes), or definite (progressive weakness and electrophysiological or pathological evidence of neuromuscular pathology).

Results: Of 69 patients identified with HANWS, 27 had definite HANWS, 19 probable, and 23 possible. Read More

Lancet Infect Dis 2003 Oct;3(10):609-10

Department of Infectious Diseases, General Hospital and Macchi Foundation, Varese, Italy.

AIDS 2003 May;17(8):1266-7

Comp Immunol Microbiol Infect Dis 2001 Jan;24(1):1-20

Laboratorio Virus Animales, Centro de Microbiología v Biologia Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.

The bovine immunodeficiency virus (BIV)/New Zealand (Oryctolagus cuniculus) rabbit model was used to study events that underlie the early and chronic stages of viral replication, routes and time course of viral dissemination and the distribution of the virus in the lymphoid. nonlymphoid and mucosa associated tissues. The results indicated that BIV, a lentivirus with genetic relatedness to the HIV, induced changes of clinical (anorexia, weight loss, muscular wasting, diarrhea, hypoalgesia, torticollis), immunological (recurrent T- and B-cell dysfunctions) and histopathological (lymphadenopathy, splenomegaly) nature that closely parallels those described for cat (Fly), monkey (SIV) and human (HIV) lentiviral diseases. Read More

Ann Intern Med 2000 Aug;133(3):192-6

Warren Grant Magnuson Clinical Center, National Institute of Allergy and Infectious Diseases Intramural AIDS Program. National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.

Background: An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported.

Objective: To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine.

Design: Case series. Read More

Semin Neurol 1999 ;19(2):165-76

Department of Neurology, The Children's Hospital of Philadelphia, Pennsylvania, USA.

HIV-1 infection in children and adolescents can cause progressive neurologic disease, affective brain growth, motor function, and neurodevelopment. In addition, myelopathies, neuropathies, myopathies, strokes, and psychiatric or behavioral manifestations can be a result of HIV-1 infection, OI, or toxicities of treatment interventions. CNS OI are important causes of morbidity and mortality, often mimicking the HIV-1 associated neurologic syndromes. Read More

Lancet 1999 Sep;354(9184):1084-9

Service d'Immunologie Hématologie Pédiatrique and INSERM U429 Laboratory, Hôpital Necker, Paris, France.

Background: Zidovudine is commonly administered during pregnancy to prevent mother-to-child HIV-1 transmission. We investigated mitochondrial toxic effects in children exposed to zidovudine in utero and after birth.

Methods: We analysed observations of a trial of tolerance of combined zidovudine and lamivudine and preliminary results of a continuing retrospective analysis of clinical and biological symptoms of mitochondrial dysfunction in children born to HIV-1-infected women in France. Read More

Muscle Nerve 1998 Dec;21(12):1680-5

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus 43210, USA.

Human immunodeficiency virus (HIV-1) associated myopathy can be a debilitating disease in humans, leading to weakness, myalgia, and muscle wasting. Subclinical neuromuscular involvement is also common. A range of histologic lesions have been described in both forms that include both inflammatory and degenerative changes. Read More

Sante 1997 May-Jun;7(3):187-93

Département de neurologie, Mont-Amba de l'Université de Kinshasa, République démocratique du Congo.

The central nervous system (CNS) is often affected by HIV-1 infection. Over 40% of AIDS cases present with neurological symptoms and CNS lesion are detected by anatomical and pathological studies in 80 to 90% of AIDS cases. There may be infections and tumors secondary to the immunodeficiency and pathologies may occur directly due to the neurotropism of the virus. Read More

Brain 1996 Dec;119 ( Pt 6):1887-93

Neuromuscular Diseases Section, National Institute of Neurologic Disorders and Stroke, NIH, Bethesda, Maryland 20892-1382, USA.

Sporadic inclusion body myositis (IBM) is the most common inflammatory myopathy affecting patients over the age of 50 years. Dysimmune and degenerative aetiologies have been postulated, but viral infections have not been associated with the disease. Two HIV-I (human immunodeficiency virus type 1) infected men and one woman infected with HTLV-1 (human T cell leukaemia virus type 1) developed progressive proximal muscle weakness unrelated to antiretroviral therapy. Read More

J Acquir Immune Defic Syndr Hum Retrovirol 1996 Oct;13(2):101-16

Laboratory of Molecular Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.

In an effort to augment human immunodeficiency virus type 1 (HIV-1) gene expression in transgenic mice, an infectious proviral DNA clone was modified by deleting the two NF kappa B binding sites and some adjacent upstream LTR sequences and replacing them with the core enhancer of Moloney murine leukemia virus (MLV). Two independent lines of MLV/HIV transgenic mice were established that expressed HIV-1-specific RNA in lymphoid tissue, striated skeletal muscle, and the eye lens. Heterozygous animals from each transgenic line spontaneously developed an inflammatory disease of the eye associated with the production of copious amounts of purulent lacrimal secretions beginning at 2 weeks of age. Read More

Sante 1996 Jul-Aug;6(4):245-8

Service de radiologie, CHU de Yopougon, Cote d'lvoire.

Subcutaneous and soft tissue involvement is frequent in AIDS patients. Although the relevant clinical characteristics have been extensively described in the literature, there has been little work on the radiological features. We therefore report three cases of AIDS with subcutaneous and soft tissue involvement: two cases of pyomyositis and one case of non-Hodgkin's lymphoma. Read More

AIDS 1996 Apr;10(4):385-91

Department of Internal Medicine, University of Texas-Houston Medical School 77030, USA.

Objective: To study the epidemiological, clinical, serological and immunogenetic features of the diffuse infiltrative lymphocytosis syndrome (DILS).

Design: Consecutive series of 35 patients with DILS diagnosed from 1992 to 1995 in a cohort of 4100 outpatients infected with HIV-1.

Methods: Thirty-five individuals with DILS were ascertained from this cohort and followed for 720 patient-months. Read More

Rheum Dis Clin North Am 1996 Feb;22(1):53-73

College of Physicians and Surgeons, Columbia University, New York, USA.

Several rheumatic illnesses may develop in adults with primary or acquired immunologic defects. Individuals with primary defects in B-cell antibody production, such as common variable immunodeficiency of selective IgA deficiency, and those with defects of complement components, have an increased prevalence of systemic lupus erythematosus--like syndromes or other autoimmune diseases. Defects in immunoglobulin production may be complicated by inflammatory or infectious arthritis. Read More

Med Clin (Barc) 1995 Oct;105(13):500-3

Servicio de Medicina Interna General, Hospital Clínic i Provincial, Barcelona.

Background: Several cases of nemaline myopathy (NM) have been described in patients with human immunodeficiency virus (HIV) infection. The clinical and histological characteristics of classical NM are known, but remain to be defined in HIV positive patients.

Methods: A retrospective review of the NM over a 12-year period (1982-1993) was carried out. Read More

J Acquir Immune Defic Syndr Hum Retrovirol 1995 Apr;8(5):466-73

Department of Medicine, FL 33136, USA.

A total of 113 patients with infection due to human T-cell leukemia virus type 1 (HTLV-I) were evaluated at the University of Miami from January 1988 to March 1993. Forty patients were identified with adult T-cell leukemia/lymphoma (ATLL) and 63 with HTLV-I-associated myelopathy (HAM). Three had concomitant ATLL and HAM. Read More

Mod Pathol 1994 Apr;7(3):369-75

Department of Pathology, SUNY, Stony Brook.

The purpose of this study was to determine if the myopathy that commonly occurs in patients with AIDS is associated with active HIV-1 infection in the muscle tissues. Seven muscle biopsies from patients infected by HIV-1 and six controls were tested for HIV-1 DNA and RNA using polymerase chain reaction in situ hybridization and reverse transcriptase in situ polymerase chain reaction. HIV-1 DNA was detected in rare cells in only one case by standard in situ hybridization. Read More

Muscle Nerve 1994 Jan;17(1):16-30

Department of Neurology, Columbian-Presbyterian Medical Center, New York, New York.

Neuromuscular diseases occur in as many as 50% of patients infected with human immunodeficiency virus type 1 (HIV-1). All forms of neuromuscular disease have been reported, including axonal neuropathy, demyelinating neuropathy, mononeuropathy multiplex, polyradiculitis, ALS-like syndromes, disorders of neuromuscular transmission, myopathy, and toxic neuropathies due to medication side effects. Neuromuscular disease is often the presenting manifestation of HIV-1 infection. Read More

Baillieres Clin Neurol 1993 Nov;2(3):659-91

Neuromuscular Diseases Section, National Institutes of Health, Bethesda, Maryland 20892.

The human immunodeficiency virus (HIV), the human T cell lymphotropic virus (HTLV-1), the human foamy retrovirus and the simian immunodeficiency viruses have been associated with the development of an inflammatory myopathy in humans and primates. The myopathy caused by HIV and HTLV-1 is not due to direct infection of the muscle by these viruses, but rather due to an immunopathologic process triggered by the viruses, mediated by autoaggressive CD8+ cells in the context of MHC-class I antigen expression. This has been based on a series of studies utilizing immunocytochemistry, in situ hybridization, polymerase chain reaction, and co-cultivation of human myotubes with the viruses or with HIV-1 and HTLV-1-infected homologous lymphoid cells. Read More

J Hand Surg Am 1993 Sep;18(5):865-7

Department of Orthopaedics and Physical Rehabilitation, University of Massachusetts Medical Center, Worcester 01655.

South Med J 1993 Aug;86(8):865-6

Department of Neurology, University of Miami School of Medicine, FL 33136.

Human immunodeficiency virus type 1 (HIV-1) is frequently associated with weakness and muscle wasting, referred to as HIV-1 wasting myopathy. This illness, often observed in the advanced stages of acquired immunodeficiency syndrome (AIDS), responds poorly to therapeutic intervention. We describe the cases of three AIDS patients with HIV-1 wasting myopathy who had a favorable response to anabolic steroids as evidenced by an improvement in strength, muscle bulk, body weight, and sense of well-being. Read More

Neurology 1993 May;43(5):971-6

Department of Neurology, Mount Sinai Medical Center, New York, NY.

Myopathy may occur as a complication of human immunodeficiency virus type 1 (HIV) infection or from its treatment, zidovudine (ZDV). We reviewed our experience with HIV-infected subjects referred for neuromuscular evaluation and compared features of myopathy in ZDV-treated (+ZDV) and untreated (-ZDV) patients. Fifty patients had myopathy, 25 diagnosed by pathologic criteria and 25 by clinical and other laboratory support. Read More

An Med Interna 1992 Nov;9(11):557-9

Servicio de Medicina Interna, Hospital Clínico Universitario, Valencia.

We present a case of an active homosexual patient who was a paid donor of plasma and presented myopathy associated to infection by the human immunodeficiency virus type 1 (HIV-1). In the ultrastructural study of the muscular biopsy, we stress the formation of central intermyofibrillary "minocores", as well as the presence of nuclear extrusions in which the core is surrounded by mitochondrial accumulations. We review the clinical, histological and ultrastructural characteristics used to identity this pathology against the group of myopathies induced by zidovudine, as well as the several empirical therapies currently recommended. Read More

Am J Med 1992 May;92(5):580-1

Baillieres Clin Neurol 1992 Apr;1(1):175-209

Westminster Hospital, London, UK.

HIV-1-related neurological diseases, excluding opportunistic infections and HIV encephalitis, are considered here. Most occur in severely immunosuppressed patients, with CD4 counts of under 200 x 10(6) l-1. Primary brain lymphoma and metastases from systemic non-Hodgkin's lymphoma, the second commonest cause of cerebral mass lesions in AIDS, are usually aggressive B cell tumours. Read More

Med Hypotheses 1992 Mar;37(3):137-50

Max-Planck-Institut für Zellbiologie, Ladenburg, Federal Republic of Germany.

Infection with the human immunodeficiency virus type 1 (HIV-1) results in a variety of pathological changes culminating in the acquired immune deficiency syndrome (AIDS). While most of these changes can readily be accounted for either by direct effects of HIV-1 on the immune system or by indirect effects of secondary infectious agents as a result of faulty immune surveillance, the direct cause for a number of disease states, including some neuropathies, myopathies, nephropathy, thrombocytopenia, wasting syndromes and increased incidence of cancers (primarily lymphoma) has remained an enigma. We have recently shown that the HIV-1 protease, a viral encoded enzyme necessary for virus maturation and infectivity, can cleave a variety of host cell cytoskeletal proteins in vitro. Read More

Dis Markers 1991 Nov-Dec;9(6):341-2

Brain Pathol 1991 Apr;1(3):143-52

Neurological Institute, University of Vienna, Wien, Austria.