Neuromuscular complications in HIV

Verma, Susama; Micsa, Elena; Estanislao, Lydia; Simpson, David M.

doi:10.1007/s11910-004-0014-8

Cited by 18 publications

(10 citation statements)

References 51 publications

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“…Neuromuscular complications are frequently observed in HIV-infected patients, and most common are neuropathy, especially distal sensory neuropathy (DSN) and myopathy. 69 Identified risk factors for DSN include history of AIDS diagnosis, older than 40 years at time of nadir CD4 cell count, diabetes mellitus, white race, alcohol abuse, male gender, signs of increased disease severity (low CD4 count and increased viral load), and nutritional deficiencies (low serum hydroxocobalamin levels). [70][71][72][73] Morgello et al correlated opiate and sedative abuse and dependence with asymptomatic DSN and ethanol and hallucinogen syndromes with symptomatic DSN in HIV-infected patients and speculated that substance abusers may react differently to sensory disturbance by increased or decreased tolerance.…”

Section: Neuromuscular Adverse Effectsmentioning

confidence: 99%

“…74 HIV-infected patients with myopathy have symmetrical proximal muscle weakness in the extremities with potential elevation of serum creatine kinase levels, and this complication is not associated with immunosuppression at a particular disease stage. 69 Most important, neuromuscular complications may also be ADRs of certain antiretroviral agents. Among them, neuropathy is primarily seen with the NRTIs ddI, stavudine (d4T), zalcitabine (ddc), and lamivudine (3TC), while myopathy may be caused by AZT and d4T.…”

Section: Neuromuscular Adverse Effectsmentioning

confidence: 99%

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Adverse Effects Associated With Antiretroviral Therapy and Potential Management Strategies

Rudorf

Krikorian

2005

Journal of Pharmacy Practice

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A variety of adverse drug reactions (ADRs) affecting many organ systems may be observed with antiretroviral therapy (ARV), and they can be differentiated into short- and long- term effects, class effects, or individual drug effects. Commonly seen ADRs include dermatological reactions, associated with nonnucleoside reverse transcriptase inhibitors (NNRTIs) and some protease inhibitors (PIs), and gastrointestinal problems, a major side effect of PIs and of some nucleoside reverse transcriptase inhibitors (NRTIs). Metabolic complications are frequently reported in HIV-infected patients on ARV and often coexist. Lipodystrophy, hyperinsulinemia/hyperglycemia, and bone disorders (osteoporosis, osteonecrosis) are mainly associated with PIs, while lactic acidemia/acidosis are primarily a problem of NRTIs. Hyperlipidemia may be caused by almost all PIs, few NRTIs, and NNRTIs. All antiretroviral drug classes may cause both asymptomatic and symptomatic hepatotoxicity, although nevirapine is the agent most implicated in hepatic events. More drug-specific ADRs include nephrotoxicity (indinavir and tenofovir), central nervous system problems (efavirenz), hematological disturbances (zidovudine), and hypersensitivity reactions (abacavir). Anticipation of ADRs may influence a patient’s decision to delay ARV or to choose specific and potentially less active agents. Occurrence of ADRs may significantly impact a patient’s quality of life and drug adherence. Pharmacists counseling HIV-infected patients should be aware of common ADRs with ARV and potential management strategies.

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Section: Neuromuscular Adverse Effectsmentioning

confidence: 99%

Section: Neuromuscular Adverse Effectsmentioning

confidence: 99%

Adverse Effects Associated With Antiretroviral Therapy and Potential Management Strategies

Rudorf

Krikorian

2005

Journal of Pharmacy Practice

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“…Outcome is good for patients with CD4 + T cell counts above 200 cells/μl, although some residual weakness may linger 88 but also increases susceptibility to other forms of peripheral neuropathy such as distal sensory polyneuropathy.°M otor Neuron Disease Syndrome: a amyotrophic lateral sclerosis-like syndrome rarely occurs in patients with HIV infection but responds to highly active antiretroviral therapy 89°E ntrapment/Mono-neuropathies Neuropathies: predominantly carpal tunnel syndrome, meralgia paresthetica and radiculopathies 68°A utonomic neuropathy: present in 12% of HIV-1 seropositive patients, and is frequently observed in conjunction with distal sensory polyneuropathy with associated postural hypotension, gastroparesis and impotence 90,91 .°M yopathies: Proximal muscle weakness with or without myalgias and evidence of polymyositis (elevated creatine kinase or inflammation on biopsy). Other common myopathies are caused by zidovudine or HMG-CoA reductase inhibitors (statins) 92 . • Neurocognitive dysfunction: Memory impairment, poor concentration, psychomotor slowing.…”

Section: Treatmentmentioning

confidence: 99%

NeuroAIDS: An Evolving Epidemic

Power

Boissé

Rourke

et al. 2009

Can. J. Neurol. Sci

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Over 60,000 Canadians are infected with human immunodeficiency virus (HIV). Greater than 50% of these individuals will develop a neurological disorder despite the availability of highly active antiretroviral therapy. HIV causes nervous system disease at all stages of infection with adverse effects on quality of life, adherence to medications, employment and survival. These disorders include opportunistic infections in addition to distinct HIV-associated neurological syndromes and undesirable treatment-related effects. The latter two groups of disorders are often undiagnosed and untreated in both adolescents and adults. Direct HIV infection of central nervous system causes HIV-associated dementia, which is a progressive subcortical dementia. HIV infection of the peripheral nervous system produces a painful sensory neuropathy termed distal sensory polyneuropathy, which may be exacerbated by several antiretroviral drugs. Other important HIV-induced neurological disorders include vacuolar myelopathy and an increased risk of seizures. Future issues that will confound the presentation and treatment of HIV-induced nervous system disorders include the increasing prevalence of drug-resistant HIV strains, increasing age of HIV-infected patients, hepatitis C virus co-infection and the Immune Reconstitution Inflammatory Syndrome. Herein, we review the clinical presentations, underlying pathogenesis and treatments of this burgeoning group of neurological disorders.

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“…A variety of neuromuscular complications may occur in patients with HIV (Verma, Micsa, Estanislao, & Simpson, 2004), the most common of which is distal symmetrical polyneuropathy (Verma et al, 2004;Williams, Geraci, & Simpson, 2002). The condition, caused by abnormalities in peripheral nerve function, is characterized by pain and by numbness in the lower extremities (Williams et al, 2002) and has been associated with advanced HIV infection, high viral load, and reduced CD4 levels (Childs et al, 1999;Williams et al, 2002).…”

Section: Neurologic and Psychologic Consequences Of Hiv Infectionmentioning

confidence: 99%

Neurologic and Psychiatric Complications of Antiretroviral Agents

Raines¹,

Radcliffe²,

Treisman³

2005

Journal of the Association of Nurses in AIDS Care

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Advances in highly active antiretroviral therapy (HAART) aim to improve the efficacy of HIV drugs as well as the quality of life in HIV-infected patients. Neurologic and psychologic disturbances that occur because of HIV disease and therapy are of great concern, and because they can overlap and are often difficult to distinguish, their pathogenesis is not clearly understood. Furthermore, these complications can lead to decreased adherence, thereby interfering with treatment outcomes. Antiretrovirals, including nonnucleoside reverse transcriptase inhibitors, can penetrate the central nervous system (CNS) and suppress viral replication, but they can also exacerbate CNS side effects and neuropsychiatric symptoms. When deciding which HAART drug combination is most appropriate for a patient, clinicians must consider the individual's risk of CNS complications together with the efficacy of the specific HAART regimen.

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Neuromuscular complications in HIV

Cited by 18 publications

References 51 publications

Adverse Effects Associated With Antiretroviral Therapy and Potential Management Strategies

Adverse Effects Associated With Antiretroviral Therapy and Potential Management Strategies

NeuroAIDS: An Evolving Epidemic

Neurologic and Psychiatric Complications of Antiretroviral Agents

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