1
|
Le Quang M, Solé G, Martin-Négrier ML, Mathis S. Clinical and pathological aspects of toxic myopathies. J Neurol 2024; 271:5722-5745. [PMID: 38907023 DOI: 10.1007/s00415-024-12522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
As the most frequent cause of acquired myopathy, toxic myopathies are characterised by clinicopathological features that vary depending on the mode of action of the drugs or toxins involved. Although a large number of substances can induce myotoxicity, the main culprits are statins, alcohol, and corticosteroids. A rigorous, well-organised diagnostic approach is necessary to obtain a rapid diagnosis. For early diagnosis and management, it is important for clinicians to be aware that most toxic myopathies are potentially reversible, and the goal of treatment should be to avoid serious muscle damage.
Collapse
Affiliation(s)
- Mégane Le Quang
- Department of Pathology, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Guilhem Solé
- Department of Neurology, Nerve-Muscle Unit, AOC Reference for Neuromuscular Disorders, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Marie-Laure Martin-Négrier
- Department of Pathology, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, AOC Reference for Neuromuscular Disorders, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France.
| |
Collapse
|
2
|
Guo L, Liu X, Su X. The role of TEMRA cell-mediated immune senescence in the development and treatment of HIV disease. Front Immunol 2023; 14:1284293. [PMID: 37901239 PMCID: PMC10602809 DOI: 10.3389/fimmu.2023.1284293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Human Immunodeficiency Virus (HIV) has plagued human society for a long time since its discovery, causing a large number of patients to suffer and costing hundreds of millions of medical services every year. Scientists have found that HIV and antiretroviral therapy accelerate immune aging by inducing mitochondrial dysfunction, and that terminal effector memory T cells (TEMRA cells) are crucial in immune aging. This specific subset of effector memory T cells has terminally differentiated properties and exhibits high cytotoxicity and proinflammatory capacity. We therefore explored and described the interplay between exhaustion features, essential markers, functions, and signaling pathways from previous studies on HIV, antiretroviral therapy, immune senescence, and TEMRA cells. Their remarkable antiviral capacity is then highlighted by elucidating phenotypic changes in TEMRA cells during HIV infection, describing changes in TEMRA cells before, during, and after antiretroviral therapy and other drug treatments. Their critical role in complications and cytomegalovirus (CMV)-HIV superinfection is highlighted. These studies demonstrate that TEMRA cells play a key role in the antiviral response and immune senescence during HIV infection. Finally, we review current therapeutic strategies targeting TEMRA cells that may be clinically beneficial, highlight their potential role in HIV-1 vaccine development, and provide perspectives and predictions for related future applications.
Collapse
Affiliation(s)
- Lihui Guo
- Department of Burns and Plastic Surgery, Yanbian University Hospital, Yanji, China
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, China Medical University, Shen Yang, China
| | - Xudong Liu
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, China Medical University, Shen Yang, China
| | - Xin Su
- Department of Burns and Plastic Surgery, Yanbian University Hospital, Yanji, China
| |
Collapse
|
3
|
Vogt S, Kleefeld F, Preusse C, Arendt G, Bieneck S, Brunn A, Deckert M, Englert B, Goebel HH, Masuhr A, Neuen-Jacob E, Kornblum C, Reimann J, Montagnese F, Schoser B, Stenzel W, Hahn K. Morphological and molecular comparison of HIV-associated and sporadic inclusion body myositis. J Neurol 2023; 270:4434-4443. [PMID: 37280376 PMCID: PMC10243696 DOI: 10.1007/s00415-023-11779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The molecular characteristics of sporadic inclusion body myositis (sIBM) have been intensively studied, and specific patterns on the cellular, protein and RNA level have emerged. However, these characteristics have not been studied in the context of HIV-associated IBM (HIV-IBM). In this study, we compared clinical, histopathological, and transcriptomic patterns of sIBM and HIV-IBM. METHODS In this cross-sectional study, we compared patients with HIV-IBM and sIBM based on clinical and morphological features as well as gene expression levels of specific T-cell markers in skeletal muscle biopsy samples. Non-disease individuals served as controls (NDC). Cell counts for immunohistochemistry and gene expression profiles for quantitative PCR were used as primary outcomes. RESULTS 14 muscle biopsy samples (7 HIV-IBM, 7 sIBM) of patients and 6 biopsy samples from NDC were included. Clinically, HIV-IBM patients showed a significantly lower age of onset and a shorter period between symptom onset and muscle biopsy. Histomorphologically, HIV-IBM patients showed no KLRG1+ or CD57+ cells, while the number of PD1+ cells did not differ significantly between the two groups. All markers were shown to be significantly upregulated at gene expression level with no significant difference between the IBM subgroups. CONCLUSION Despite HIV-IBM and sIBM sharing important clinical, histopathological, and transcriptomic signatures, the presence of KLRG1+ cells discriminated sIBM from HIV-IBM. This may be explained by longer disease duration and subsequent T-cell stimulation in sIBM. Thus, the presence of TEMRA cells is characteristic for sIBM, but not a prerequisite for the development of IBM in HIV+ patients.
Collapse
Affiliation(s)
- Sinja Vogt
- Department of Neurology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Felix Kleefeld
- Department of Neurology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
- BIH Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Corinna Preusse
- Department of Neuropathology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | | | - Stefan Bieneck
- Department of Internal Medicine, Rheumatology, Schlosspark-Klinik, 14059, Berlin, Germany
| | - Anna Brunn
- Faculty of Medicine, Institute of Neuropathology, University Hospital Cologne, 50937, Cologne, Germany
| | - Martina Deckert
- Faculty of Medicine, Institute of Neuropathology, University Hospital Cologne, 50937, Cologne, Germany
| | - Benjamin Englert
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, 81337, Munich, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Anja Masuhr
- Department of Internal Medicine, Infectiology, Auguste-Viktoria-Klinikum, 12157, Berlin, Germany
| | - Eva Neuen-Jacob
- Department of Neuropathology, University Hospital Düsseldorf, 40225, Düsseldorf, Germany
| | - Cornelia Kornblum
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Jens Reimann
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Federica Montagnese
- Department of Neurology, Friedrich-Baur-Institute, University Hospital Munich, 80336, Munich, Germany
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, University Hospital Munich, 80336, Munich, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany.
| | - Katrin Hahn
- Department of Neurology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany.
| |
Collapse
|
4
|
Al Amrani F, Al-Abdwani R, Al Rashdi F, Al-Ajmi E, Al Futaisi A. Guillain-Barré Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients. Sultan Qaboos Univ Med J 2023; 23:400-404. [PMID: 37655082 PMCID: PMC10467552 DOI: 10.18295/squmj.5.2022.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a recognised complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 who presented to a tertiary centre in Muscat, Oman in 2021: The first patient was a three-month-old female infant who presented with bradypnea, encephalopathy, and generalised weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a six-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery.
Collapse
Affiliation(s)
- Fatema Al Amrani
- Pediatric Neurology Unit, Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Raghad Al-Abdwani
- Pediatric Intensive Care Unit, Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al Rashdi
- Pediatric Emergency Unit, Emergency Medicine Department, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Amna Al Futaisi
- Pediatric Neurology Unit, Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
5
|
Chatterjee T, Arora I, Underwood LB, Lewis TL, Masjoan Juncos JX, Heath SL, Goodin BR, Aggarwal S. Heme-Induced Macrophage Phenotype Switching and Impaired Endogenous Opioid Homeostasis Correlate with Chronic Widespread Pain in HIV. Cells 2023; 12:1565. [PMID: 37371035 PMCID: PMC10297192 DOI: 10.3390/cells12121565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic widespread pain (CWP) is associated with a high rate of disability and decreased quality of life in people with HIV-1 (PWH). We previously showed that PWH with CWP have increased hemolysis and elevated plasma levels of cell-free heme, which correlate with low endogenous opioid levels in leukocytes. Further, we demonstrated that cell-free heme impairs β-endorphin synthesis/release from leukocytes. However, the cellular mechanisms by which heme dampens β-endorphin production are inconclusive. The current hypothesis is that heme-dependent TLR4 activation and macrophage polarization to the M1 phenotype mediate this phenomenon. Our novel findings showed that PWH with CWP have elevated M1-specific macrophage chemokines (ENA-78, GRO-α, and IP-10) in plasma. In vitro, hemin-induced polarization of M0 and M2 macrophages to the M1 phenotype with low β-endorphins was mitigated by treating cells with the TLR4 inhibitor, TAK-242. Similarly, in vivo phenylhydrazine hydrochloride (PHZ), an inducer of hemolysis, injected into C57Bl/6 mice increased the M1/M2 cell ratio and reduced β-endorphin levels. However, treating these animals with the heme-scavenging protein hemopexin (Hx) or TAK-242 reduced the M1/M2 ratio and increased β-endorphins. Furthermore, Hx attenuated heme-induced mechanical, heat, and cold hypersensitivity, while TAK-242 abrogated hypersensitivity to mechanical and heat stimuli. Overall, these results suggest that heme-mediated TLR4 activation and M1 polarization of macrophages correlate with impaired endogenous opioid homeostasis and hypersensitivity in people with HIV.
Collapse
Affiliation(s)
- Tanima Chatterjee
- Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, PBMR 230, 901 19th Street South, Birmingham, AL 35205, USA; (T.C.); (L.B.U.); (T.L.L.); (J.X.M.J.)
| | - Itika Arora
- Division of Developmental Biology and the Reproductive Sciences Center, Cincinnati Children’s Hospital, Cincinnati, OH 45229, USA;
| | - Lilly B. Underwood
- Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, PBMR 230, 901 19th Street South, Birmingham, AL 35205, USA; (T.C.); (L.B.U.); (T.L.L.); (J.X.M.J.)
| | - Terry L. Lewis
- Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, PBMR 230, 901 19th Street South, Birmingham, AL 35205, USA; (T.C.); (L.B.U.); (T.L.L.); (J.X.M.J.)
| | - Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, PBMR 230, 901 19th Street South, Birmingham, AL 35205, USA; (T.C.); (L.B.U.); (T.L.L.); (J.X.M.J.)
| | - Sonya L. Heath
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL 35205, USA;
| | - Burel R. Goodin
- Washington University Pain Center, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - Saurabh Aggarwal
- Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, PBMR 230, 901 19th Street South, Birmingham, AL 35205, USA; (T.C.); (L.B.U.); (T.L.L.); (J.X.M.J.)
| |
Collapse
|
6
|
Wang J, Zhang Y, Wang M, Ren Y, Tang M, Liu L, Zhou D. Intravenous immunoglobulin therapy for HIV-associated Guillain-Barré syndrome. Int Immunopharmacol 2022; 112:109192. [PMID: 36155283 DOI: 10.1016/j.intimp.2022.109192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the efficacy of intravenous immunoglobulin (IVIG) added to antiretroviral therapy (ART) and ART alone in people living with human immunodeficiency virus-associated Guillain-Barré syndrome (HIV-associated GBS). METHODS The study was a retrospective analysis of clinical records of HIV-associated GBS patients from department of neurology at West China Hospital between January 2015 and October 2020. Patients treated with ART alone were compared with those treated with IVIG + ART. The primary outcome was the GBS disability score at 4 weeks, which was assessed with multivariable ordinal regression. Additional outcomes include the GBS disability scale at 1 week, improvement of ≥ 1 point on the GBS disability score at 1 and 4 weeks, median change in the MRC sum score at 1 and 4 weeks, number of patients who were able to walk independently at 4 weeks. RESULTS Two hundred and fifty-two (252) individuals living with HIV were recruited in the study. According to the inclusion and exclusion criteria, 21 HIV-associated GBS patients were finally included, of whom 8 were treated with IVIG + ART and 13 were treated with ART alone. At the fourth weeks after treatment, the GBS disability scale grade was significantly lower in patients treated with IVIG + ART than those with ART alone (1 vs. 2, P = 0.02). The adjusted OR for a lower GBS disability scale was 10.6 (95 % CI 1.15 to 98.05; P = 0.03) for the IVIG + ART group. Moreover, 6 of 8 (75 %) patients treated with IVIG + ART were able to walk independently at four weeks after treatment. CONCLUSIONS The introduction of IVIG combined with ART may be efficacious in the treatment of HIV-infected GBS and may provide better clinical outcomes.
Collapse
Affiliation(s)
- Jierui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, Sichuan, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Ren
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng Tang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
7
|
Luciano CA, Caraballo-Cartagena S. Treatment and Management of Infectious, Granulomatous, and Toxic Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Strength and endurance exercises on balance impairment, gait disturbance, and quality of life of persons living with HIV-related distal symmetrical polyneuropathy: A study protocol. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Abstract
The evolution of therapeutics for and management of human immunodeficiency virus-1 (HIV-1) infection has shifted it from predominately manifesting as a severe, acute disease with high mortality to a chronic, controlled infection with a near typical life expectancy. However, despite extensive use of highly active antiretroviral therapy, the prevalence of chronic widespread pain in people with HIV remains high even in those with a low viral load and high CD4 count. Chronic widespread pain is a common comorbidity of HIV infection and is associated with decreased quality of life and a high rate of disability. Chronic pain in people with HIV is multifactorial and influenced by HIV-induced peripheral neuropathy, drug-induced peripheral neuropathy, and chronic inflammation. The specific mechanisms underlying these three broad categories that contribute to chronic widespread pain are not well understood, hindering the development and application of pharmacological and nonpharmacological approaches to mitigate chronic widespread pain. The consequent insufficiencies in clinical approaches to alleviation of chronic pain in people with HIV contribute to an overreliance on opioids and alarming rise in active addiction and overdose. This article reviews the current understanding of the pathogenesis of chronic widespread pain in people with HIV and identifies potential biomarkers and therapeutic targets to mitigate it.
Collapse
Affiliation(s)
- Dylan R Addis
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer J DeBerry
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saurabh Aggarwal
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
10
|
Concurrent Myotonic Dystrophy and Inflammatory Myopathy in a Patient with HIV/AIDS. Case Rep Infect Dis 2021; 2021:9998415. [PMID: 34104500 PMCID: PMC8159637 DOI: 10.1155/2021/9998415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
Neuromuscular complications are common in patients with HIV/AIDS at any stage of the disease process. Myopathies can be secondary to antiretroviral therapy, HIV myositis itself, or other etiologies. Here, we present the case of a middle-aged male with HIV who presented with myalgias and was diagnosed with myotonic dystrophy and HIV-associated polymyositis after extensive workup including clinical history and physical exam, laboratory markers, electromyogram, and muscle biopsy. This case illustrates the importance of a comprehensive workup for myopathy in HIV/AIDS and the possibility of multiple concurrent conditions.
Collapse
|
11
|
Živković SA, Gruener G, Narayanaswami P. Doctor-Should I get the COVID-19 vaccine? Infection and immunization in individuals with neuromuscular disorders. Muscle Nerve 2021; 63:294-303. [PMID: 33471383 PMCID: PMC8013955 DOI: 10.1002/mus.27179] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 12/13/2022]
Abstract
The clinical course of neuromuscular disorders (NMDs) can be affected by infections, both in immunocompetent individuals, and in those with reduced immunocompetence due to immunosuppressive/immunomodulating therapies. Infections and immunizations may also trigger NMDs. There is a potential for reduced efficacy of immunizations in patients with reduced immunocompetence. The recent vaccination program for coronavirus disease-2019 (COVID-19) raises several questions regarding the safety and efficacy of this vaccine in individuals with NMDs. In this Practice Topic article, we address the role of vaccine-preventable infections in NMDs and the safety and efficacy of immunization in individuals with NMDs, with emphasis on vaccination against COVID-19.
Collapse
Affiliation(s)
- Sasha A. Živković
- Department of NeurologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Gregory Gruener
- Department of Neurology, Stritch School of MedicineLoyola UniversityChicagoIllinoisUSA
| | - Pushpa Narayanaswami
- Department of NeurologyHarvard Medical School/Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | |
Collapse
|
12
|
Ventuneac A, Hecht G, Forcht E, Duah BA, Tarar S, Langenbach B, Gates J, Cain D, Rendina HJ, Aberg JA, Perlman DC. Chronic High Risk Prescription Opioid Use Among Persons With HIV. FRONTIERS IN SOCIOLOGY 2021; 6:645992. [PMID: 34095287 PMCID: PMC8176351 DOI: 10.3389/fsoc.2021.645992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/26/2021] [Indexed: 05/07/2023]
Abstract
Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016-December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.
Collapse
Affiliation(s)
- Ana Ventuneac
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
- *Correspondence: Ana Ventuneac,
| | - Gavriella Hecht
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Emily Forcht
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Bianca A. Duah
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Shafaq Tarar
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Blanche Langenbach
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Jay Gates
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, NY, NY, United States
| | - H. Jonathon Rendina
- Department of Psychology, Hunter College, City University of New York, NY, NY, United States
- Health Psychology and Clinical Science PhD Program, The Graduate Center, City University of New York, NY, NY, United States
| | - Judith A. Aberg
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| |
Collapse
|
13
|
Tarulli A. Distal and Generalized Sensory Symptoms. Neurology 2021. [DOI: 10.1007/978-3-030-55598-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
14
|
Kietrys DM, Parrott JS, Galantino ML, Davis T, Levin T, O'Brien KK. Self-Reported Disability in Persons With HIV-Related Neuropathy Is Mediated by Pain Interference and Depression. Phys Ther 2020; 100:2174-2185. [PMID: 32914180 DOI: 10.1093/ptj/pzaa161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability. METHODS In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability. RESULTS Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056). CONCLUSION In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression. IMPACT Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression. LAY SUMMARY People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.
Collapse
Affiliation(s)
- David M Kietrys
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, 200 College Dr, Jefferson Hall #308, Blackwood, NJ 08012 (USA)
| | - James Scott Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers, The State University of New Jersey
| | - Mary Lou Galantino
- Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, New Jersey; Family Medicine and Community Health, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania; and University of Witwatersrand, Johannesburg, South Africa
| | - Tracy Davis
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers, The State University of New Jersey
| | - Todd Levin
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey; and Jefferson Health, Voorhees, New Jersey
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto; and Rehabilitation Sciences Institute, University of Toronto
| |
Collapse
|
15
|
Patterson AJ, Sarode A, Al-Kindi S, Shaver L, Thomas R, Watson E, Alaiti MA, Liu Y, Hamilton J, Seiberlich N, Rashid I, Gilkeson R, Schilz R, Hoit B, Jenkins T, Zullo M, Bossone E, Longenecker C, Simonetti O, Rajagopalan S. Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2020; 22:74. [PMID: 33040733 PMCID: PMC7549205 DOI: 10.1186/s12968-020-00664-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 08/25/2020] [Indexed: 11/15/2022] Open
Abstract
AIM Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. METHODS AND RESULTS Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO2) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO2 slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO2 measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO2 (p = 0.02, p = 0.03). CONCLUSION Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.
Collapse
Affiliation(s)
- Andrew J Patterson
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Anuja Sarode
- Kent State University, College of Public Health, Kent, OH, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Lauren Shaver
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Rahul Thomas
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Evelyn Watson
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Mohamad Amer Alaiti
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Yuchi Liu
- Michigan University, Department of Biomedical Engineering, Ann Arbor, MI, USA
| | - Jessie Hamilton
- Michigan University, Department of Biomedical Engineering, Ann Arbor, MI, USA
| | - Nicole Seiberlich
- Michigan University, Department of Biomedical Engineering, Ann Arbor, MI, USA
| | - Imran Rashid
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Robert Gilkeson
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Robert Schilz
- University Hospitals Cleveland Medical Center, Department of Pulmonology, Cleveland, OH, USA
| | - Brian Hoit
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Trevor Jenkins
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Melissa Zullo
- Kent State University, College of Public Health, Kent, OH, USA
| | | | | | - Orlando Simonetti
- Ohio State University Department of Cardiovascular Medicine, Columbus, OH, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA.
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA.
| |
Collapse
|
16
|
Maamar el Asri M, García Martínez A, Tobalina Segura M, Blanco Martín E, Pariente Rodrigo E. Necrosis avascular de ambas cabezas femorales en un paciente VIH+. Semergen 2019; 45:e11-e12. [DOI: 10.1016/j.semerg.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 10/27/2022]
|
17
|
Severe rhabdomyolysis-induced acute kidney injury following concomitant use of Genvoya® (EVG/COBI/FTC/TAF) and simvastatin; a case report. BMC Nephrol 2019; 20:69. [PMID: 30808332 PMCID: PMC6390564 DOI: 10.1186/s12882-019-1257-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background Genvoya® (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide) is a recent single regimen for the treatment of Human Immunodeficiency Virus (HIV). However, because of its complexity, it is difficult to predict drug interactions, especially when associated with HMG-CoA reductase inhibitors and/or in the setting of other comorbidities. We discuss the mechanisms of these potential drug interactions as the cause of rhabdomyolysis and acute kidney injury in the context of prior and current medication therapy with possible underlying liver and kidney dysfunction. Case presentation We describe the case of a 54-year-old man diagnosed with HIV who developed severe rhabdomyolysis-induced anuric acute kidney injury (AKI) requiring renal replacement therapy following introduction of Genvoya® concomitantly with simvastatin, in the context of recently diagnosed hepatitis C and hepatitis A. Haemodialysis was continued over 5 weeks followed by progressive clinical and biological improvements. Five months later, a new antiretroviral regimen was started and has been well tolerated. Conclusion Simvastatin, as well as lovastatin, because of their CYP3A4 metabolism, and to a lesser extent atorvastatin, which is only partially metabolized by CYP3A4, are the HMG-CoA reductase inhibitors with the greatest risk of drug interactions and should not be used in patients under HIV-therapy. Patients receiving HMG-CoA reductase inhibitors should be monitored regularly for the occurrence of muscular adverse effects and drug interactions should be considered with each new prescription or change in clinical status. There are many online tools that enable clinicians to rapidly check for drug interactions. We recommend the one from the University of Liverpool for patients under HIV-therapy (https://www.hiv-druginteractions.org/checker), while for patients under hepatitis C-therapy, we advise to consult http://www.hep-druginteractions.org/. This case illustrates the importance of multidisciplinary collaboration in the treatment of HIV-positive patients because of their complexity, associated comorbidities and the potential of multiple drug-drug interactions potentially exacerbated by underlying liver and/or kidney dysfunction.
Collapse
|
18
|
Abstract
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
Collapse
|
19
|
Palma P, Costa A, Duro R, Neves N, Abreu C, Sarmento A. Mononeuritis multiplex: an uncommon neurological manifestation of cytomegalovirus reactivation in an HIV-infected patient. BMC Infect Dis 2018; 18:554. [PMID: 30419847 PMCID: PMC6233374 DOI: 10.1186/s12879-018-3501-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/02/2018] [Indexed: 03/11/2023] Open
Abstract
Background Cytomegalovirus (CMV) reactivation with neurological involvement in patients with acquired immunodeficiency syndrome (AIDS) is increasingly rare since the introduction of antiretroviral therapy (ART). Manifestations include encephalitis, myelitis, polyradiculopathy and, less commonly, mononeuritis multiplex (MNM). We report a case of disseminated CMV disease with gastrointestinal and peripheral and central nervous system involvement in a patient with AIDS, manifesting primarily as MNM. Case presentation A 31-year old woman with AIDS presented with a clinical picture of MNM. Electromyography confirmed the clinical findings. CMV DNA was detected in cerebrospinal fluid (CSF) and blood. Gastrointestinal involvement was histologically documented. HIV RNA was also detected in CSF and brain MRI was consistent with HIV encephalopathy. A diagnosis of disseminated CMV disease (with esophagitis, colitis, encephalitis and MNM) and HIV encephalopathy was made. Treatment consisted of ganciclovir and foscarnet, followed by maintenance therapy with valganciclovir. Evolution was favorable and valganciclovir was stopped after sustained immune recovery following ART initiation. Conclusion We discuss the diagnostic approach to CMV neurological disease, with a focus on MNM and CMV encephalitis. Combination therapy with ganciclovir and foscarnet should be considered for all forms of neurological involvement, although available data are scarce. Since there is significant overlap between CMV encephalitis and HIV encephalopathy, ART drugs with higher CSF penetration may have to be considered. ART and immune recovery are essential to improve outcomes.
Collapse
Affiliation(s)
- Pedro Palma
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. .,Instituto de Inovação e Investigação em Saúde (I3S). Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
| | - Andreia Costa
- Neurology Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Raquel Duro
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde (I3S). Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Nélia Neves
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde (I3S). Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Cândida Abreu
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde (I3S). Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde (I3S). Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| |
Collapse
|
20
|
Mathis S, Magy L, Le Masson G, Richard L, Soulages A, Solé G, Duval F, Ghorab K, Vallat JM, Duchesne M. Value of nerve biopsy in the management of peripheral neuropathies. Expert Rev Neurother 2018; 18:589-602. [DOI: 10.1080/14737175.2018.1489240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stéphane Mathis
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Laurent Magy
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Gwendal Le Masson
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Laurence Richard
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Antoine Soulages
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
| | - Guilhem Solé
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Fanny Duval
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Karima Ghorab
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Jean-Michel Vallat
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Mathilde Duchesne
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
- Department of Pathology, University Hospital, Limoges, France
| |
Collapse
|
21
|
Neuromuscular diseases associated with Human Immunodeficiency Virus infection. J Neurol Sci 2018; 387:27-36. [PMID: 29571868 DOI: 10.1016/j.jns.2018.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/15/2017] [Accepted: 01/12/2018] [Indexed: 01/31/2023]
Abstract
From the most common distal symmetric polyneuropathy (Bilgrami and O'Keefe, 2014) to the rare motor neuron diseases, HIV infection is associated with pathology at all levels of the peripheral nervous system. HIV infection can cause these conditions due to viral exposure itself, the resulting immune dysregulation, opportunistic infections found in untreated patients, and from the therapy used in treatment of the virus. Before the advent of antiretroviral therapy, 5 neuromuscular diseases associated with HIV often resulted from opportunistic infections. With advances in antiretroviral therapy, the etiologies of neuromuscular complications more frequently become the result of prolonged HIV exposure, comorbid diseases, and side effects of medications. In this article we review the literature on HIV associated neuromuscular diseases, emphasizing the more recent studies in the post antiretroviral era, but also reviewing conditions more prevalent in the pre antiretroviral era which continue to be seen in developing countries and resource poor areas. This discussion includes the following conditions: distal symmetric polyneuropathy, autonomic neuropathy, inflammatory demyelinating polyneuropathy, mononeuropathy, mononeuropathy multiplex, polyradiculopathies, myelopathy, myopathy, motor neuron disease, and antiretroviral treatment related conditions.
Collapse
|
22
|
Couture P, Malfatti E, Morau G, Mathian A, Cohen-Aubart F, Nielly H, Amoura Z, Cherin P. Inclusion body myositis and human immunodeficiency virus type 1: A new case report and literature review. Neuromuscul Disord 2018; 28:334-338. [PMID: 29426734 DOI: 10.1016/j.nmd.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/22/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Abstract
Prevalence of muscle disease in human immunodeficiency virus (HIV) infection is less than 1% of patients with acquired immune deficiency syndrome. Sporadic inclusion body myositis (IBM) is observed in a few cases of patients infected by retroviruses such as HIV-1. A Caucasian man was diagnosed with HIV when he was 30 years old. The viral load was undetectable and CD4 cell count was 600/mm3 when the diagnosis of inclusion body myositis was confirmed. Histological findings were typical of IBM. The treatment consisted of immunoglobulin therapy for three years without effect. Twenty-two patients were found in the English and French literature. They are younger than those who suffer from IBM without HIV (median age = 47, range: 30 to 59), and they are mostly men with considerable serum creatine kinase (CK) elevation (median CK level = 1322 IU/L, range: 465 to 10270), most of them were treated with Zidovudine.
Collapse
Affiliation(s)
- Priscille Couture
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Médecine Interne 2, Centre National de Référence des Maladies Auto-Immunes Systémiques et Rares. Institut E3M. 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Edoardo Malfatti
- Assistance Publique-Hôpitaux de Paris, Unité de Morphologie Neuromusculaire - Institut de myologie, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Geneviève Morau
- Assistance Publique-Hôpitaux de Paris, Maladie infectieuse et tropicale, Hôpital Bichat Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - Alexis Mathian
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Médecine Interne 2, Centre National de Référence des Maladies Auto-Immunes Systémiques et Rares. Institut E3M. 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Fleur Cohen-Aubart
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Médecine Interne 2, Centre National de Référence des Maladies Auto-Immunes Systémiques et Rares. Institut E3M. 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Hubert Nielly
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Médecine Interne 2, Centre National de Référence des Maladies Auto-Immunes Systémiques et Rares. Institut E3M. 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Zahir Amoura
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Médecine Interne 2, Centre National de Référence des Maladies Auto-Immunes Systémiques et Rares. Institut E3M. 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Patrick Cherin
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Médecine Interne 2, Centre National de Référence des Maladies Auto-Immunes Systémiques et Rares. Institut E3M. 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| |
Collapse
|
23
|
Wright EJ, Thakur KT, Bearden D, Birbeck GL. Global developments in HIV neurology. HANDBOOK OF CLINICAL NEUROLOGY 2018; 152:265-287. [PMID: 29604981 DOI: 10.1016/b978-0-444-63849-6.00019-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurologic conditions associated with HIV remain major contributors to morbidity and mortality, and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence suggests that the central nervous system (CNS) serves as a reservoir for viral replication with major implications for human immunodeficiency virus (HIV) eradication strategies. Though there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of HIV-associated neurologic conditions, significant scientific gaps remain. In many low-income settings, second- and third-line cART regimens that carry substantial neurotoxicity remain treatment mainstays. Further, patients continue to present severely immunosuppressed with CNS opportunistic infections. Public health efforts should emphasize improvements in access and optimizing treatment of HIV-positive patients, specifically in resource-limited settings, to reduce the risk of neurologic sequelae.
Collapse
Affiliation(s)
- Edwina J Wright
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Australia; The Burnet Institute, Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Columbia University Medical Center, New York, NY, United States
| | - David Bearden
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gretchen L Birbeck
- Strong Epilepsy Center, Department of Neurology, University of Rochester, Rochester, NY, United States; Chikankata Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
| |
Collapse
|
24
|
Mhariwa PC, Myezwa H, Galantino ML, Maleka D. The relationship between lower limb muscle strength and lower extremity function in HIV disease. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:360. [PMID: 30135905 PMCID: PMC6093131 DOI: 10.4102/sajp.v73i1.360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 07/11/2017] [Indexed: 11/01/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) negatively impacts muscle strength and function. This study aimed to establish the relationship between lower limb muscle strength and lower extremity function in HIV disease. Method A cross-sectional study was undertaken with a sample of 113 HIV-positive participants. Lower limb muscle strength and self-reported function were established using dynamometry and the Lower Extremity Functional Scale (LEFS), respectively. Muscle strength and functional status were established in a subset of 30 HIV-negative participants to determine normative values. Results Muscle strength for participants with HIV ranged from an ankle dorsiflexion mean of 9.33 kg/m2 to 15.79 kg/m2 in hip extensors. In the HIV-negative group, ankle dorsiflexors recorded 11.17 kg/m2, whereas hip extensors were the strongest, generating 17.68 kg/m2. In the HIV-positive group, linear regression showed a positive relationship between lower limb muscle strength and lower extremity function (r = 0.71, p = 0.00). Fifty per cent of the changes in lower extremity function were attributable to lower limb muscle strength. A simple linear regression model showed that lower limb ankle plantar flexors contributed the most to lower extremity function in this cohort, contrary to the literature which states that hip and trunk muscles are the most active in lower limb functional activities. Conclusion Lower extremity strength impacts perceived function in individuals stabilised on antiretroviral therapy for HIV disease. These findings demonstrate that ankle plantar flexors produce more force over hip flexors. Careful attention should be paid to the implications for strength training in this population.
Collapse
Affiliation(s)
- Peter C Mhariwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mary L Galantino
- Stockton University Physical Therapy Program, Galloway, New Jersey, United States.,School of Medicine - CCEB, University of Pennsylvania, United States
| | - Douglas Maleka
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| |
Collapse
|
25
|
Ambrosioni J, Artigues F, Nicolás D, Peñafiel J, Agüero F, Manzardo C, Mar Mosquera M, Sánchez-Palomino S, De Lazzari E, Marcos MA, Plana M, Miró JM. Neurological involvement in patients with acute/recent HIV-1 infection. A case-control study. J Neurovirol 2017; 23:679-685. [PMID: 28718069 DOI: 10.1007/s13365-017-0548-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/13/2017] [Indexed: 01/30/2023]
Abstract
Primary HIV-1 infection is a relevant period for its virological and epidemiological consequences. Most patients present a symptomatic disease that can be potentially serious, but neurological involvement during primary HIV-1 infection has been poorly studied. The aim of this study was to describe the characteristics and outcomes of primary HIV-1 infection patients presenting neurological symptoms and to compare them with primary HIV-1 infection patients without neurological involvement. Retrospective case-control study (1:3) comparing primary HIV-1 infection patients with and without neurological involvement enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016. Matching criteria included age (±10 years), gender, year of diagnosis (±4 years), and Fiebig stage. The conditional logit model was used for comparisons. Fourteen out of 463 patients (3.02%) enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016 presented neurological symptoms. 28.5% of cases presented as meningitis and 71.5% as meningoencephalitis. Cerebrospinal fluid showed non-specific findings, including pleocytosis with lymphocyte predominance and increased protein levels. All cases required hospitalisation, whereas only 19% of the controls did. No other pathogen was identified in any case, but five patients initiated empirically antimicrobial treatment for other aetiologies until diagnosis was confirmed. CD4/CD8 ratio was significantly lower (p = 0.039) and plasmatic viral load significantly higher in the case group, compared to controls (p = 0.028). Risk factors, HIV-1 tropism, subtype distribution, and prescribed ART regimens were comparable between cases and controls. After 6 months on ART, 92% of cases had undetectable viral load, similar to controls, and CD4/CD8 ratio became also comparable between groups. All cases recovered rapidly with ART and were discharged without sequels. Neurological involvement during primary HIV-1 infection is unusual but serious, always requiring hospitalisation. Diagnosis is difficult because of the wide range of symptoms and similarities with other viral aetiologies. Neurological manifestations during primary HIV-1 infection are associated with a lower CD4/CD8 ratio and with a higher viral load than controls. Immediate ART initiation and rapid viral load decrease are required, allowing complete clinical recovery.
Collapse
Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | | | - David Nicolás
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Judit Peñafiel
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Fernando Agüero
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - María Mar Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - Sonsoles Sánchez-Palomino
- Laboratory of Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - María A Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Laboratory of Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain.
| |
Collapse
|
26
|
Wang K, Coyle ME, Mansu S, Zhang AL, Xue CC. Gentiana scabraBunge. Formula for Herpes Zoster: Biological Actions of Key Herbs and Systematic Review of Efficacy and Safety. Phytother Res 2017; 31:375-386. [DOI: 10.1002/ptr.5769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/29/2016] [Accepted: 12/21/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Kaiyi Wang
- China-Australia International Research Centre for Chinese Medicine (CAIRCCM), School of Health and Biomedical Sciences; RMIT University; Bundoora Campus Melbourne VIC 3083 Australia
| | - Meaghan E. Coyle
- China-Australia International Research Centre for Chinese Medicine (CAIRCCM), School of Health and Biomedical Sciences; RMIT University; Bundoora Campus Melbourne VIC 3083 Australia
- Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong China
| | - Suzi Mansu
- China-Australia International Research Centre for Chinese Medicine (CAIRCCM), School of Health and Biomedical Sciences; RMIT University; Bundoora Campus Melbourne VIC 3083 Australia
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine (CAIRCCM), School of Health and Biomedical Sciences; RMIT University; Bundoora Campus Melbourne VIC 3083 Australia
| | - Charlie Changli Xue
- China-Australia International Research Centre for Chinese Medicine (CAIRCCM), School of Health and Biomedical Sciences; RMIT University; Bundoora Campus Melbourne VIC 3083 Australia
- Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong China
| |
Collapse
|
27
|
Kolson D. Neurologic Complications in Persons With HIV Infection in the Era of Antiretroviral Therapy. TOPICS IN ANTIVIRAL MEDICINE 2017; 25:97-101. [PMID: 28820724 PMCID: PMC5935214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neurologic complications in persons with HIV infection are less severe in the era of potent antiretroviral therapy but remain highly prevalent. Prior to the use of antiretroviral therapy, opportunistic infections of the central nervous system (CNS) and CNS malignancy were common. Progressive multifocal leukoencephalopathy (PML), however, remains a diagnostic challenge in HIV-infected individuals, and no effective antiviral treatment for PML is currently available. Primary neurologic complications of acute HIV infection include aseptic meningitis and acute inflammatory demyelinating polyneuropathy. Among the neurologic complications of chronic HIV infection, HIV-associated neurocognitive disorders (HAND) remain most prevalent. The use of antiretroviral therapy has greatly reduced the severity of HAND, under which progressive HIV-associated dementia once predominated, to a milder chronic form of potentially disabling neurocognitive impairment. The persistence of HAND in individuals with virologic suppression suggests a need for adjunctive therapies for limiting its morbidity. This article summarizes a presentation by Dennis Kolson, MD, PhD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Chicago, Illinois, in May 2017.
Collapse
|
28
|
Virot E, Duclos A, Adelaide L, Miailhes P, Hot A, Ferry T, Seve P. Autoimmune diseases and HIV infection: A cross-sectional study. Medicine (Baltimore) 2017; 96:e5769. [PMID: 28121924 PMCID: PMC5287948 DOI: 10.1097/md.0000000000005769] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To describe the clinical manifestations, treatments, prognosis, and prevalence of autoimmune diseases (ADs) in human immunodeficiency virus (HIV)-infected patients.All HIV-infected patients managed in the Infectious Diseases Department of the Lyon University Hospitals, France, between January 2003 and December 2013 and presenting an AD were retrospectively included.Thirty-six ADs were found among 5186 HIV-infected patients which represents a prevalence of 0.69% including immune thrombocytopenic purpura (n = 15), inflammatory myositis (IM) (n = 4), sarcoidosis (n = 4), Guillain-Barré syndrome (GBS) (n = 4), myasthenia gravis (n = 2), Graves' disease (n = 2), and 1 case of each following conditions: systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis and autoimmune hemolytic anemia. One patient presented 2 ADs. Thirty patients were known to be HIV-infected when they developed an AD. The AD preceded HIV infection in 2 patients. GBS and HIV infection were diagnosed simultaneously in 3 cases. At AD diagnosis, CD4 T lymphocytes count were higher than 350/mm in 63% of patients, between 200 and 350/mm in 19% and less than 200/mm in 19%. Twenty patients benefited from immunosuppressant treatments, with a good tolerance.ADs during HIV infection are uncommon in this large French cohort. Immune thrombocytopenic purpura, sarcoidosis, IM, and GBS appear to be more frequent than in the general population. Immunosuppressant treatments seem to be effective and well tolerated.
Collapse
Affiliation(s)
- Emilie Virot
- Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Antoine Duclos
- Pôle Information Médicale Evaluation Recherche des Hospices Civils de Lyon
| | - Leopold Adelaide
- Département de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Patrick Miailhes
- Département de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Arnaud Hot
- Université de Lyon, Université Lyon 1
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Département de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
- Université de Lyon, Université Lyon 1
| | - Pascal Seve
- Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
- Université de Lyon, Université Lyon 1
| |
Collapse
|
29
|
Moodley K, Bill PLA, Patel VB. A comparative study of CIDP in a cohort of HIV-infected and HIV-uninfected patients. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 4:e315. [PMID: 28054000 PMCID: PMC5182055 DOI: 10.1212/nxi.0000000000000315] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate differences in clinical presentation, electrodiagnostic measures, CSF changes, and treatment outcome measures in HIV-infected and HIV-uninfected patients with chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS A retrospective analysis of medical records of all patients meeting the European Federation of Neurology diagnostic criteria for idiopathic CIDP was performed in 2 neuromuscular units in Kwa-Zulu Natal between 2003 and 2015. RESULTS Eighty-four patients were included in the study; 39 were HIV-infected and 45 were HIV-uninfected. Among the HIV-infected patients, the majority were younger, were female, and had a monophasic progressive illness. Eighty-six percent (86%) were corticosteroid-responsive and 76% were in remission within 6-12 months requiring no further treatment. Among the HIV- uninfected patients, the majority were older, were male, and had a relapsing-remitting course. Twenty-seven percent (27%) were corticosteroid-responsive, 95% required combination therapy, and 33% were not in remission by 18 months on therapy. CONCLUSION This study shows that HIV-infected patients with CIDP were younger, were more often female, displayed a monophasic progressive course, were highly steroid-responsive, and went into remission within 12 months of corticosteroid initiation.
Collapse
Affiliation(s)
- Kaminie Moodley
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Pierre L A Bill
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Vinod Bhagu Patel
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
30
|
Woldeamanuel YW, Kamerman PR, Veliotes DGA, Phillips TJ, Asboe D, Boffito M, Rice ASC. Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings. PLoS One 2016; 11:e0164994. [PMID: 27764177 PMCID: PMC5072607 DOI: 10.1371/journal.pone.0164994] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 10/04/2016] [Indexed: 02/02/2023] Open
Abstract
HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study–HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman’s Rho), and inter-tester concordance > 0.93 (Spearman’s Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet pain can be used to identify those with neuropathic pain.
Collapse
Affiliation(s)
- Yohannes W. Woldeamanuel
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Neurology, Addis Abäba University School of Medicine, College of Health Sciences, Addis Abäba, Ethiopia
- Advanced Clinical Consultation & Research Center, Addis Abäba, Ethiopia
- * E-mail:
| | - Peter R. Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Demetri G. A. Veliotes
- Division of Neurology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tudor J. Phillips
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Pain Relief Unit, The Churchill Hospital, Oxford, United Kingdom
| | - David Asboe
- The Pain Relief Unit, The Churchill Hospital, Oxford, United Kingdom
| | - Marta Boffito
- HIV Medicine and Sexual Health, Chelsea and Westminster Hospital, London, United Kingdom
| | - Andrew S. C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
31
|
Merlin JS, Bulls HW, Vucovich LA, Edelman EJ, Starrels JL. Pharmacologic and non-pharmacologic treatments for chronic pain in individuals with HIV: a systematic review. AIDS Care 2016; 28:1506-1515. [PMID: 27267445 DOI: 10.1080/09540121.2016.1191612] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic pain occurs in as many as 85% of individuals with HIV and is associated with substantial functional impairment. Little guidance is available for HIV providers seeking to address their patients' chronic pain. We conducted a systematic review to identify clinical trials and observational studies that examined the impact of pharmacologic or non-pharmacologic interventions on pain and/or functional outcomes among HIV-infected individuals with chronic pain in high-development countries. Eleven studies met inclusion criteria and were mostly low or very low quality. Seven examined pharmacologic interventions (gabapentin, pregabalin, capsaicin, analgesics including opioids) and four examined non-pharmacologic interventions (cognitive behavioral therapy, self-hypnosis, smoked cannabis). The only controlled studies with positive results were of capsaicin and cannabis, and had short-term follow-up (≤12 weeks). Among the seven studies of pharmacologic interventions, five had substantial pharmaceutical industry sponsorship. These findings highlight several important gaps in the HIV/chronic pain literature that require further research.
Collapse
Affiliation(s)
- Jessica S Merlin
- a Divisions of Infectious Diseases and Gerontology, Geriatrics and Palliative Care , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Hailey W Bulls
- b Department of Psychology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Lee A Vucovich
- c Lister Hill Library, Lister Hill Library of the Health Sciences , University of Alabama at Birmingham , Birmingham , AL , USA
| | - E Jennifer Edelman
- d Department of Internal Medicine , Yale University School of Medicine and Center for Interdisciplinary Research on AIDS, Yale University School of Public Health , New Haven , CT , USA
| | - Joanna L Starrels
- e Division of General Internal Medicine , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| |
Collapse
|
32
|
Panos G, Watson DC, Karydis I, Velissaris D, Andreou M, Karamouzos V, Sargianou M, Masdrakis A, Chra P, Roussos L. Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: a case report and review of the literature. J Med Case Rep 2016; 10:165. [PMID: 27268102 PMCID: PMC4895963 DOI: 10.1186/s13256-016-0902-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 04/17/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Acute cauda equina syndrome is an uncommon but significant neurologic presentation due to a variety of underlying diseases. Anatomical compression of nerve roots, usually by a lumbar disk hernia is a common cause in the general population, while inflammatory, neoplastic, and ischemic causes have also been recognized. Among human immunodeficiency virus (HIV) infected patients with acquired immunodeficiency syndrome, infectious causes are encountered more frequently, the most prevalent of which are: cytomegalovirus, herpes simplex virus 1/2, varicella zoster virus, and Mycobacterium tuberculosis infections. Studies of cauda equina syndrome in well-controlled HIV infection are lacking. We describe such a case of cauda equina syndrome in a well-controlled HIV-infected patient, along with a brief review of the literature regarding the syndrome's diagnosis and treatment in individuals with HIV infection. CASE PRESENTATION A 36-year-old Greek male, HIV-positive patient presented with perineal and left hemiscrotal numbness, lumbar pain, left-sided sciatica, and urinary incontinence. Magnetic resonance imaging of the patient's lumbar spine revealed intrathecal migration of a fragment from an intervertebral lumbar disk exerting pressure on the cauda equina. A cerebrospinal fluid examination, brain computed tomography scan, spine magnetic resonance imaging, and serological test results were negative for central nervous system infections. Our patient underwent emergency neurosurgical spinal decompression, which resolved most symptoms, except for mild urinary incontinence. CONCLUSIONS Noninfectious etiologies may also cause cauda equina syndrome in HIV-infected individuals, especially in well-controlled disease under antiretroviral therapy. Prompt recognition and treatment of the underlying cause is important to minimize residual symptoms. Targeted antimicrobial chemotherapy is used to treat infectious causes, while prompt surgical decompression is favored for anatomical causes of cauda equina syndrome in the HIV-infected patient.
Collapse
Affiliation(s)
- George Panos
- Special Infections Unit, 2nd Internal Medicine Clinic, 1st Ι.Κ.Α. Penteli General Hospital, Melissia, Athens, Greece. .,Department of Infectious Diseases, Patras University General Hospital, 26504, Rion, Patras, Greece.
| | - Dionysios C Watson
- Department of Infectious Diseases, Patras University General Hospital, 26504, Rion, Patras, Greece
| | - Ioannis Karydis
- Special Infections Unit, 2nd Internal Medicine Clinic, 1st Ι.Κ.Α. Penteli General Hospital, Melissia, Athens, Greece
| | - Dimitrios Velissaris
- Internal Medicine Department, University Hospital of Patras, 26504, Rion, Patras, Greece
| | - Marina Andreou
- Internal Medicine Department, University Hospital of Patras, 26504, Rion, Patras, Greece
| | - Vasilis Karamouzos
- Internal Medicine Department, University Hospital of Patras, 26504, Rion, Patras, Greece
| | - Maria Sargianou
- Department of Infectious Diseases, Patras University General Hospital, 26504, Rion, Patras, Greece
| | - Antonios Masdrakis
- Special Infections Unit, 2nd Internal Medicine Clinic, 1st Ι.Κ.Α. Penteli General Hospital, Melissia, Athens, Greece
| | - Paraskevi Chra
- Department of Microbiology, Benakio-Korgialenio Hospital, 1 Erythrou Staurou Street, 11526, Athens, Greece
| | - Lavrentios Roussos
- Neurosurgery Clinic, Κ.Α.Τ. Hospital, 2 Nikis Street, 14561, Kifissia, Athens, Greece
| |
Collapse
|
33
|
Ducci RDP, de Magalhães FB, Collares D, Lorenzoni PJ, Gomes-da-Silva MM, Kay CSK, Carvalho M, Werneck LC, Scola RH. Necrotizing myopathy: An uncommon initial manifestation of human immunodeficiency virus. Muscle Nerve 2016; 54:334-5. [PMID: 26969883 DOI: 10.1002/mus.25097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | | | - Daniel Collares
- Division of Neurology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Mauricio Carvalho
- Internal Medicine Department, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Lineu César Werneck
- Division of Neurology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | |
Collapse
|
34
|
Distal and Generalized Sensory Symptoms. Neurology 2016. [DOI: 10.1007/978-3-319-29632-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
35
|
Steyl T, Shayo FT. The role of physiotherapy in the treatment of HIV-related sensory neuropathy: The perceptions and referral practices of physicians. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:286. [PMID: 30135881 PMCID: PMC6093136 DOI: 10.4102/sajp.v71i1.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/29/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND HIV-related peripheral neuropathies are among the most prevalent chronic neurological disorders affecting persons living with HIV and AIDS. In order to improve the physical function and quality of life of those affected by the disease, a holistic or multidisciplinary approach, including physiotherapy, has been suggested for the management of neuropathic pain. AIM The aim of this study was to explore the physicians' perceptions regarding the role of physiotherapy in the management of patients with HIV-sensory neuropathy (HIV-SN) and their referral practices in Tanzania. METHODS A qualitative study design incorporating purposive sampling was employed in the study. A total of 10 physicians from a hospital in Tanzania agreed to participate in in-depth interviews. RESULTS Physicians had poor perceptions of the role of physiotherapy in the management of patients with HIV-SN. Their inadequate knowledge of the role of physiotherapy and the limited number of physiotherapists employed negatively influenced their referral of patients with HIV-SN for physiotherapy. CONCLUSION In Tanzania, referral for physiotherapy is still dependent on medical doctors. Inter-professional learning is imperative for minimising the stereotypes that may exist across professions, hence the need to improve awareness of specific roles in patient management. This could improve knowledge of the role of other professionals in the management and rehabilitation of affected patients and consequently improve perceptions and facilitate referrals of patients with HIV-SN for more integrated care.
Collapse
Affiliation(s)
- Tania Steyl
- Department of Physiotherapy, University of the Western Cape, South Africa
| | - Felista T. Shayo
- Department of Physiotherapy, University of the Western Cape, South Africa
| |
Collapse
|
36
|
Mocumbi AO. Cardiac Disease and HIV in Africa: A Case for Physical Exercise. Open AIDS J 2015; 9:62-5. [PMID: 26587074 PMCID: PMC4645865 DOI: 10.2174/1874613601509010062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/08/2015] [Accepted: 08/16/2015] [Indexed: 11/24/2022] Open
Abstract
AIDS-related deaths and new HIV infections have declined globally, but continue to be a major problem in Africa. Prior to the advent of antiretroviral treatment (ART) HIV patients died of immunodeficiency and associated opportunistic infections; Highly Active Antiretroviral Therapy (HAART) has resulted in increased survival of these patients and has transformed this illness into a chronic condition. Cardiovascular, respiratory, neurological and muscular problems interfere with exercise in HIV-infected patients. Particularly cardiovascular disease may be associated with direct damage by the virus, by antiretroviral therapy and by malnutrition and chronic lung disease, resulting in physical and psychological impairment. Recent studies have shown the benefits of exercise training to improvement of physiologic and functional parameters, with the gains being specific to the type of exercise performed. Exercise should be recommended to all HIV patients as an effective prevention and treatment for metabolic and cardiovascular syndromes associated with HIV and HAART exposure in sub-Saharan Africa.
Collapse
Affiliation(s)
- Ana Olga Mocumbi
- Instituto Nacional de Saúde & Universidade Eduardo Mondlane, Av. Eduardo Mondlane 1008, Maputo, Moçambique
| |
Collapse
|
37
|
Rosca EC, Rosca O, Simu M. Intravenous immunoglobulin treatment in a HIV-1 positive patient with Guillain-Barré syndrome. Int Immunopharmacol 2015; 29:964-965. [PMID: 26428850 DOI: 10.1016/j.intimp.2015.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
Abstract
We report the case of an HIV-1 positive patient with primary demyelinating neuropathy (Guillain-Barré syndrome); after intravenous immunoglobulin treatment (IVIG), he presented with an increase in CD4 and CD8 cell counts and a decrease in plasma viral load. Currently, there is little reported research regarding IVIG treatment in adults with HIV-1. The present report brings further evidence regarding the possible benefit of IVIG in HIV-1 infected patients, providing a novel perspective on treatment.
Collapse
Affiliation(s)
- Elena Cecilia Rosca
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Neurology, Romania; Clinical Emergency County Hospital Timisoara, Department of Neurology, Romania.
| | - Ovidiu Rosca
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Infectious Diseases, Romania
| | - Mihaela Simu
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Neurology, Romania; Clinical Emergency County Hospital Timisoara, Department of Neurology, Romania
| |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Infections are important, potentially treatable causes of peripheral nervous system disease. This article reviews the clinical presentation and management of several common peripheral nervous system diseases due to viral, bacterial, spirochetal, and parasitic infections. RECENT FINDINGS The clinical presentation and evaluation of infectious peripheral nervous system diseases are well established. Advances in the treatment and, in some cases, the prevention of these diseases are still evolving. SUMMARY A diverse range of peripheral nervous system diseases, including peripheral neuropathy, radiculopathy, radiculomyelopathy, cranial neuropathy, and motor neuropathy, are caused by numerous infectious agents. In some patients, peripheral neuropathy may be a side effect of anti-infectious drugs. Infectious neuropathies are important to recognize as they are potentially treatable. This article discusses the clinical presentation, evaluation, and treatment of several common peripheral nervous system diseases caused by viral, bacterial, spirochetal, and parasitic infections, as well as some peripheral nerve disorders caused by adverse effects of the treatments of these infectious diseases.
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW To present an overview of HIV-associated distal symmetric polyneuropathy (HIV-DSP) and other HIV-related peripheral neuropathies in the post-highly active retroviral therapy era. RECENT FINDINGS HIV-DSP has become the most common neurologic complication of HIV largely due to the prolonged survival of HIV-positive patients with the advent of highly active retroviral therapy. HIV-DSP can be attributed to the disease itself or to secondary effects of certain HAART agents, and often the two disease entities cannot be distinguished. HIV-DSP can lead to significant morbidity and interfere with daily activities. Diagnosis can be obtained from a detailed history and neurologic exam revealing absent ankle jerks and abnormal, vibratory perception or decreased pinprick or temperature. Supporting studies include nerve conduction studies and skin biopsy. Although there are no United States Food and Drug Administration-approved treatments for HIV-DSP, clinicians often use off-label medications, including antidepressants, anticonvulsants, topical agents and other analgesics. SUMMARY The prevalence of those affected by HIV-DSP will continue to grow with the aging population of HIV-infected individuals. Compared to the diabetic neuropathy drug trials, trials in both symptomatic and disease-modifying agents for HIV-DSP have had little success. Other forms of HIV-related peripheral neuropathies are discussed briefly, and include acute and chronic inflammatory demyelinating polyneuropathy, autonomic neuropathy, polyradiculopathy, mononeuropathies, mononeuritis multiplex, cranial neuropathies, and amyotrophic lateral sclerosis-like motor neuropathy.
Collapse
|
40
|
Abstract
Muscle tissue is highly sensitive to many substances. Early recognition of toxic myopathies is important, because they potentially are reversible on removal of the offending drug or toxin, with greater likelihood of complete resolution the sooner this is achieved. Clinical features range from mild muscle pain and cramps to severe weakness with rhabdomyolysis, renal failure, and even death. The pathogenic bases can be multifactorial. This article reviews some of the common toxic myopathies and their clinical presentation, histopathologic features, and possible underlying cellular mechanisms.
Collapse
Affiliation(s)
- Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| |
Collapse
|
41
|
Abstract
Orthopaedic surgeons frequently treat patients who report pain that radiates from the back into the lower extremity. Although the most common etiology is either a herniated disk or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy, resulting in differences in the clinical presentation and the workup. Therefore, the clinician must be able to distinguish the signs and symptoms of lumbar radiculopathy from pathologies that may have a similar presentation. Being cognizant of these other possible conditions enables the physician to consider a breadth of alternative diagnoses when a patient presents with radiating lower extremity pain.
Collapse
|
42
|
Bielec D, Kiciak S, Przybyła A, Stempkowska J. Improvement of distal symmetrical polyneuropathy in patient with AIDS after switch from protease inhibitor containing antiretroviral treatment to tenofovir disoproxil fumarate, emtricitabine and rilpivirine (EVIPLERA®) therapy – Case report. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
43
|
Jehangir W, Sareen R, Sen S, Raoof N, Yousif A. Acute Confusional State: A Manifestation of Toxoplasma and CMV Co-infection in HIV Patient. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:545-8. [PMID: 25489570 PMCID: PMC4215495 DOI: 10.4103/1947-2714.143290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context: When dealing with a patient with HIV that presents with an altered mental status, there are various infections and disease etiologies a physician has to rule out that may play a role in complicating the inherent complex nature of HIV. Toxoplasma gondii (T. gondii) and cytomegalovirus (CMV) affect a large part of the world's population and lead to a varied and broad symptomatology depending upon the severity of HIV, the CD4 count and how early the infection is diagnosed. Case Report: We report an HIV+ patient in his early 50s and with a low CD4 count that presented with severe lethargy and confusion. Imaging studies that were performed after stabilizing the patient revealed a ring-enhancing lesion in the brain and after further testing, a diagnosis of reactivated T. gondii with co-infection with CMV was made. Patients infected with T. gondii that are already immune-compromised deteriorate rapidly and the disease diagnosis poses several challenges. Conclusion: Clinicians have to be extremely careful about making a prompt diagnosis and initiate treatment without delay before the infection takes a deadly toll on the patient. Since our patient was not on the required prophylactic medication to prevent infection with T. gondii, it was imperative to start treatment in a timely manner and to monitor the patient for any further decline in functioning.
Collapse
Affiliation(s)
- Waqas Jehangir
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Romil Sareen
- Ross University School of Medicine, Portsmouth, Dominica, USA
| | - Shuvendu Sen
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Nazar Raoof
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Abdalla Yousif
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| |
Collapse
|
44
|
Quality of life and self-reported lower extremity function in adults with HIV-related distal sensory polyneuropathy. Phys Ther 2014; 94:1455-66. [PMID: 24853912 DOI: 10.2522/ptj.20130337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Distal sensory polyneuropathy (DSP) is a common complication of HIV disease. Its effects on quality of life (QOL) and function have not been well described. OBJECTIVE The study objectives were: (1) to compare QOL and lower extremity function in people with HIV-related DSP and people with HIV disease who do not have DSP, (2) to determine the extent to which function predicts QOL, (3) to evaluate the agreement of 2 function scales, and (4) to describe the use of pain management resources. DESIGN This was a cross-sectional survey study with predictive modeling and measurement tool concordant validation. METHODS A demographic questionnaire, the Medical Outcomes Study HIV Health Survey, the Lower Extremity Functional Scale (LEFS), the Lower Limb Functional Index (LLFI), and a review of medical records were used. General linear modeling was used to assess group differences in QOL and the relationship between function and QOL. Bland-Altman procedures were used to assess the agreement of the LEFS and the LLFI. RESULTS Usable data for analyses were available for 82 of the 94 participants enrolled. The 67% of participants who reported DSP symptoms tended to be older, had HIV disease longer, and were more likely to receive disability benefits. Participants without DSP had better LLFI, LEFS, and physical health summary scores. In multivariate models, lower limb function predicted physical and mental health summary scores. The LLFI identified participants with a lower level of function more often than the LEFS. Participants with DSP were more likely to use medical treatment, physical therapy, and complementary or alternative treatments. LIMITATIONS A sample of convenience was used; the sample size resulted in a low power for the mental health summary score of the Medical Outcomes Study HIV Health Survey. CONCLUSIONS Quality of life and function were more impaired in participants with HIV disease and DSP. The LLFI was more likely to capture limitations in function than the LEFS. Participants with DSP reported more frequent use of pain management resources.
Collapse
|
45
|
Gardner K, Hall PA, Chinnery PF, Payne BAI. HIV treatment and associated mitochondrial pathology: review of 25 years of in vitro, animal, and human studies. Toxicol Pathol 2013; 42:811-22. [PMID: 24067671 DOI: 10.1177/0192623313503519] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antiretroviral therapy has dramatically reduced mortality in human immunodeficiency virus (HIV) infection. In 1988, the suggestion that the first antiretroviral drug, zidovudine, was the potential cause of muscle pathology in HIV-infected persons resulted in structural and biochemical patient studies demonstrating acquired mitochondrial dysfunction. Assessment of subsequent nucleoside analog reverse transcriptase inhibitor (NRTI) antiretroviral drugs has indicated that mitochondria are a common target of NRTI toxicity in multiple tissues, leading to a wide variety of pathology ranging from lipodystrophy to neuropathy. Overwhelmingly, these complications have emerged during post-licensing human studies. Subsequent animal and in vitro studies have then elucidated the potential pathological mechanisms, suggesting that NRTI-associated mitochondrial toxicity arises principally from inhibition of the sole mitochondrial DNA (mtDNA) polymerase gamma, leading to a reduction in mtDNA content (depletion). Millions of patients have been treated with mitochondrially toxic NRTIs and these drugs remain the backbone of antiretroviral rollout in much of sub-Saharan Africa. Here we describe the 25-year history of antiretroviral associated mitochondrial pathology and critically review the strength of evidence linking clinical, histopathological, and molecular data. We discuss recently described novel mechanisms of NRTI-associated mitochondrial damage and whether or not recently licensed NRTIs may be considered free from mitochondrial toxicity.
Collapse
Affiliation(s)
- Kristian Gardner
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Peter A Hall
- AstraZeneca Pharmaceuticals, Alderley Park, Macclesfield, Cheshire, UK
| | - Patrick F Chinnery
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Brendan A I Payne
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| |
Collapse
|
46
|
Abstract
Distal symmetric polyneuropathy (DSP) related to human immunodeficiency virus (HIV) is one of the most common neurologic complications of HIV, possibly affecting as many as 50% of all individuals infected with HIV. Two potentially neurotoxic mechanisms have been proposed to play a crucial role in the pathogenesis of HIV DSP: neurotoxicity resulting from the virus and its products; as well as adverse neurotoxic effects of medications used in the treatment of HIV. Clinically, HIV DSP is characterized by a combination of signs and symptoms that include decreased deep tendon reflexes at the ankles and decreased sensation in the distal extremities as well as paresthesias, dysesthesias, and pain in a symmetric stocking-glove distribution. These symptoms are generally static or slowly progressive over time, and depending on the severity, may interfere significantly with the patient's daily activities. In addition to the clinical picture, nerve conduction studies and skin biopsies are often pursued to support the diagnosis of HIV DSP. Anticonvulsants, antidepressants, topical agents, and nonspecific analgesics may help relieve neuropathic pain. Specifically, gabapentin, lamotrigine, pregabalin, amitriptyline, duloxetine, and high-dose topical capsaicin patches have been used in research and clinical practice. Further research is needed to elucidate the pathogenesis of HIV DSP, thus facilitating the development of novel treatment strategies. This review discusses the epidemiology, pathophysiology, clinical findings, diagnosis, and management of DSP in the setting of HIV.
Collapse
Affiliation(s)
- Sonja G Schütz
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | | |
Collapse
|
47
|
Muscular weakness in individuals with HIV associated with a disorganization of the cortico-spinal tract: a multi-modal MRI investigation. PLoS One 2013; 8:e66810. [PMID: 23874398 PMCID: PMC3708953 DOI: 10.1371/journal.pone.0066810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 05/12/2013] [Indexed: 12/11/2022] Open
Abstract
Motor impairment is highly prevalent in HIV-infected patients. Here, we assess associations between peripheral muscular deficits as evaluated by the 5 sit-to-stand test (5STS) and structural integrity of the motor system at a central level. Eighty-six HIV-infected patients receiving combination antiretroviral therapy and with no major cerebral events, underwent an MRI scan and the 5STS. Out of 86 participants, forty presented a score greater than two standard deviations above mean normative scores calculated for the 5STS and were therefore considered as motor-impaired. MRI-structural cerebral parameters were compared to the unimpaired participants. Fractional Anisotropy (FA), Axial Diffusivity (AD) and Radial Diffusivity (RD), reflecting microstructural integrity, were extracted from Diffusion-Tensor MRI. Global and regional cerebral volumes or thicknesses were extracted from 3D-T1 morphological MRI. Whereas the two groups did not differ for any HIV variables, voxel-wise analysis revealed that motor-impaired participants present low FA values in various cortico-motor tracts and low AD in left cortico-spinal tract. However, they did not present reduced volumes or thicknesses of the precentral cortices compared to unimpaired participants. The absence of alterations in cortical regions holding motor-neurons might argue against neurodegenerative process as an explanation of White Matter (WM) disorganization.
Collapse
|
48
|
Abstract
The last decade has witnessed major advances in our understanding of the epidemiology and pathophysiology of HIV-related cardiovascular disease in sub-Saharan Africa. In this review, we summarise these and discuss clinically relevant advances in diagnosis and treatment. In the Heart of Soweto Study, 10% of patients with newly diagnosed cardiovascular disease were HIV positive, and the most common HIV-related presentations were cardiomyopathy (38%), pericardial disease (13%) and pulmonary arterial hypertension (8%). HIV-related cardiomyopathy is more common with increased immunosuppression and HIV viraemia. With adequate antiretroviral therapy, the prevalence is low. Contributing factors such as malnutrition and genetic predisposition are under investigation. In other settings, pericardial disease is the most common presentation of HIV-related cardiovascular disease (over 40%), and over 90% of pericardial effusions are due to Mycobacterium tuberculosis (TB) pericarditis. HIV-associated TB pericarditis is associated with a greater prevalence of myopericarditis, a lower rate of progression to constriction, and markedly increased mortality. The role of steroids is currently under investigation in the form of a randomised controlled trial. HIV-associated pulmonary hypertension is significantly more common in sub-Saharan Africa than in developed countries, possibly as a result of interactions between HIV and other infectious agents, with very limited treatment options. It has recently been recognised that patients with HIV are at increased risk of sudden death. Infection with HIV is independently associated with QT prolongation, which is more marked with hepatitis C co-infection and associated with a 4.5-fold higher than expected rate of sudden death. The contribution of coronary disease to the overall burden of HIV-associated cardiovascular disease is still low in sub-Saharan Africa.
Collapse
Affiliation(s)
- Faisal F Syed
- MRCP Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | | |
Collapse
|
49
|
Abstract
Peripheral nerve disorders are associated with all stages of HIV infection. Distal sensory polyneuropathy is characterised by often-disabling pain that is difficult to treat. It is prevalent in both high-income and low-income settings. In low-income settings, use of potentially neurotoxic antiretrovirals, which are inexpensive and widely available, contributes substantially to incidence. Research has focused on identification of factors that predict risk of distal sensory polyneuropathy and elucidation of the multifactorial mechanisms behind pathogenesis. Sensorimotor polyneuropathies and polyradiculopathies are less frequent than distal sensory polyneuropathy, but still occur in low-income settings and have potentially devastating consequences. However, many of these diseases can be treated successfully with a combination of antiretroviral and immune-modulating therapies. To distinguish between peripheral nerve disorders that have diverse, overlapping, and frequently atypical presentations can be challenging; a framework based on a clinicoanatomical approach might assist in the diagnosis and management of such disorders.
Collapse
|
50
|
Abstract
Peripheral neuropathies are the most common neurological manifestations occurring in HIV-infected individuals. Distal symmetrical sensory neuropathy is the most common form encountered today and is one of the few that are specific to HIV infection or its treatment. The wide variety of other neuropathies is akin to the neuropathies seen in the general population and should be managed accordingly. In the pre-ART era, neuropathies were categorized according to the CD4 count and HIV viral load. In the early stages of HIV infection when CD4 count is high, the inflammatory demyelinating neuropathies predominate and in the late stages with the decline of CD4 count opportunistic infection-related neuropathies prevail. That scenario has changed with the present almost universal use of ART (antiretroviral therapy). Hence, HIV-associated peripheral neuropathies are better classified according to their clinical presentations: distal symmetrical polyneuropathy, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), mononeuropathies, mononeuropathies multiplex and cranial neuropathies, autonomic neuropathy, lumbosacral polyradiculomyelopathy, and amyotrophic lateral sclerosis (ALS)-like motor neuropathy. Treated with ART, HIV-infected individuals are living longer and are at a higher risk of metabolic and age-related complications; moreover they are also prone to the potentially neurotoxic effects of ART. There are no epidemiological data regarding the incidence and prevalence of the peripheral neuropathies. In the pre-ART era, most data were from case reports, series of patients, and pooled autopsy data. At that time the histopathological evidence of neuropathies in autopsy series was almost 100%. In large prospective cohorts presently being evaluated, it has been found that 57% of HIV-infected individuals have distal symmetrical sensory neuropathy and 38% have neuropathic pain. It is now clear that distal symmetrical sensory neuropathy is caused predominantly by the ART's neurotoxic effect but may also be caused by the HIV itself. With a sizeable morbidity, the neuropathic pain caused by distal symmetrical sensory neuropathy is very difficult to manage; it is often necessary to change the ART regimen before deciding upon the putative role of HIV infection itself. If the change does not improve the pain, there are few options available; the most common drugs used for neuropathic pain are usually not effective. One is left with cannabis, which cannot be recommended as routine therapy, recombinant human nerve growth factor, which is unavailable, and topical capsaicin with its side-effects. Much has been done to and learned from HIV infection in humans; HIV-infected individuals, treated with ART, are now dying mostly from cardiovascular disease and non-AIDS-related cancers. It hence behooves us to find new approaches to mitigate the residual neurological morbidity that still impacts the quality of life of that population.
Collapse
Affiliation(s)
- Alberto Alain Gabbai
- Department of Neurology, UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil.
| | | | | |
Collapse
|