Neuromuscular complications of HIV infection

Higher iron stores and the HFE 187C>G variant delay onset of peripheral neuropathy during combination antiretroviral therapy

“…More importantly, our results suggest that higher cellular and systemic iron levels, not simply reduced inflammation related to HFE variants, may explain the reduced risk of cART-associated neuropathy that was observed with these variants in PWH. In addition, the current analysis included ACTG Study 384 participants exposed to cART that did not include the more neurotoxic dNRTIs; therefore, our findings may also advance understanding of HIV sensory neuropathy in PWH on more modern regimems, as well as PWH at risk for this condition in low-resource settings who receive older antiretroviral drugs [1,20]. Despite the small sample size, lower systemic iron stores (higher sTFR-ferritin index) independently predicted more rapid onset of neuropathy, with a potentially clinically meaningful delay in onset of 3 to 6 months.…”

“…Combination antiretroviral therapy (cART) has transformed clinical outcomes in HIV infection, and the incidence of peripheral sensory neuropathy has clearly declined as older, dideoxynucleoside reverse-transcriptase inhibitor drugs (dNRTIs) have been largely replaced by less neurotoxic drugs. HIV sensory neuropathy remains problematic, however, among people living with HIV (PWH) globally, particularly in developing countries and resource-limited settings, where dNRTIs are still used [1,2]. HIV sensory neuropathy is a painful and debilitating complication of HIV infection and its treatment with older dNRTIs, such as stavudine, and neuropathic pain occurs in up to 40% of all people with HIV (PWH), including those on contemporary cART regimens [3,4].…”

“…HIV sensory neuropathy is a painful and debilitating complication of HIV infection and its treatment with older dNRTIs, such as stavudine, and neuropathic pain occurs in up to 40% of all people with HIV (PWH), including those on contemporary cART regimens [3,4]. Predisposing factors for neuropathy include older age, greater height, prior neurotoxic exposures, advanced HIV disease, statin and fibrate use, diabetes, hypertriglyceridemia, and poor nutrition [1,2,5]. Host genetic factors, including variant cytokine genotypes and specific mitochondrial DNA haplogroups, have also been associated with susceptibility to sensory neuropathy in HIV-seropositive (HIV+) persons [3,4,6,7].…”

Doctor—Should I get the COVID‐19 vaccine? Infection and immunization in individuals with neuromuscular disorders

“…Mononeuritis multiplex due to vasculitis is a rare complication of HIV infection 16 . A progressive polyradiculopathy due to opportunistic infection with CMV is well‐known, but is also associated with lymphoma, tuberculosis, syphilis, and cryptococcus 17 . An amyotrophic lateral sclerosis (ALS)‐like syndrome has been described with HIV infection 18 .…”

Neuromuskuläre Erkrankungen bei der HIV-Infektion

“…Selten, aber klinisch relevant sind Patienten, welche sich mit einem motorischen meist proximalen Tetrasyndrom oder Myalgien neurologisch vorstellen und bei denen differenzialdiagnostisch der Verdacht auf eine Myopathie/Myositis geäußert wird. Details gehen über das Ziel dieser Zusammenfassung hinaus und sind in einem Review zusammengefasst [24] .…”