HIV Life Cycle and Antiretroviral Medications

A primary vacuolar and inflammatory myelopathy may occur in AIDS and may mimic the myelopathy of vitamin B₁₂ or copper deficiency, with predominant involvement of the posterior columns. There is no effective treatment.

Symptomatic neuropathies are common in patients infected with HIV-1, becoming more common as the immunodeficiency worsens. Distal symmetric sensory polyneuropathy (DSPN) is the most frequent, is progressive, and presents with symmetric distal pain, paresthesias, and numbness in the feet. A similar neuropathy is associated with several of the nucleoside-analog reverse-transcriptase inhibitor drugs (NRTIs—zalcitabine [ddC], didanosine [ddI], and stavudine [d4T]), used for treating HIV infection. Acute inflammatory demyelinating polyradiculopathy sometimes occur at the time of seroconversion, but polyradiculopathy may also occur at more advanced stages of HIV-1 infection. The cerebrospinal fluid (CSF) in patients with polyradiculopathy typically contains a lymphocytosis (10-50 cells/mm³). Mononeuritis multiplex is an infrequent complication of HIV-1 infection.

Patients co-infected with cytomegalovirus (CMV) may develop mononeuritis multiplex, polyradiculoneuropathy, or polyradiculopathy. The CSF may show a polymorphonuclear pleocytosis, and CMV polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) is positive in 90% of cases.

Various myopathies may occur in patients infected with HIV-1, and may require biopsy for their distinction. In rare instances, rhabdomyolysis occurs. Some patients appear to have a disorder resembling polymyositis that is steroid responsive; others develop inclusion-body myositis. Various muscle-wasting syndromes have been described, as is a vasculitic myopathy. Rod-body myopathy is characterized by the presence of rod-shaped bodies and loss of thick filaments, and it may respond to corticosteroids. Opportunistic infections of muscle sometimes occur, as in muscle toxoplasmosis, and treatment is of the offending organism. Myopathies may occur as a complication of HAART. A mitochondrial myopathy sometimes occurs in patients receiving zidovudine.

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