HIV-associated neuromuscular weakness syndrome in Brazil: report of the two first cases

Abstract

-We describe two Brazilian patients with HIV-associated neuromuscular weakness syndrome (HANWS), a unique clinical toxic syndrome that was recently reported in developed countries. Both patients were women, used stavudine and had hyperlactatemia, one of them with lactic acidosis. Eletrophysiological studies were consistent with axonal neuropathy. After discontinuation of antiretroviral therapy the patients had significant improvement in neurologic manifestations, and normalization of lactate levels. To our knowledge, this is the first report of HANWS in developing countries. Growing use of antiretroviral therapy in this setting, particularly stavudine, make it likely that similar cases will be observed.KEy WoRdS: neuromuscular diseases, peripheral neuropathies, antiretroviral agents, human immunodeficiency virus.Síndrome da fraqueza neuromuscular associada ao HIV no Brasil: relato dos dois primeiros casos RESUMo -os autores descrevem dois pacientes brasileiros com a síndrome da fraqueza neuromuscular associada ao HIV, uma síndrome tóxica, clínicamente particular, que foi recentemente relatada em paí-ses desenvolvidos. Ambas pacientes eram do sexo feminino, usavam estavudina e apresentaram hiperlactatemia, uma delas com acidose láctica. os exames electrofisiológicos foram consistentes com neuropatia axonal. As pacientes melhoraram significativamente das alterações neurológicas, assim como normalizaram os níveis de lactato, após descontinuar o uso dos antiretrovirais. Até onde sabemos, este é o primeiro relato da síndrome de fraqueza neuromuscular associada ao HIV em países em desenvolvimento. Nesse contexto, o uso crescente de antiretrovirais, particularmente a estavudina, possibilitarão que casos similares sejam observados.PAlAVRAS-CHAVE: doenças neuromusculares, neuropatia periférica, terapia antiretroviral, vírus da imunodeficiência humana.

Antiretroviral Therapy Complications and Their Correction in HIV-Infected Pregnant Women in the Perioperative Period

“…На фоне лечения препаратами часто разви вается миопатия, проявляющаяся слабостью и атрофией про ксимальных мышц, что связано, по видимому, со способнос тью зидовудина и ламивудина прочно связываться с митохондриальной ДНК полимеразой. В публикациях Mathew J. et al [10] Vidal J. E. et al [11] представлены описа ния случаев возникновения ВИЧ ассоциированного синдро ма нервно мышечной слабости у пациенток, получающих комбинированную АРВТ, в состав которой входил зидовудин и ламивудин. Одной из пациенток потребовалась продленная ИВЛ (в течение 12 часов) после общей анестезии, при этом все другие причины возникновения миопатии были исключе ны.…”