WIDE-RANGE OF NEUROMUSCULAR DISORDERS OBS ERVED IN 47 PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Over a 30 month period, 47 out of 749 patients infected with the human immunodeficiency virus had various neuromuscular symptoms. Based on c linical and electrophysiological data, 47% had distal symmetric polyne uropathy, 11% chronic inflammatory demyelinating polyneuropathy (CIDP) , 8.5% toxic neuropathy related to 2-3-dideoxyinosine (DDI), 8.5% cran ial neuropathy, 8.5% mononeuropathy multiplex or isolated focal neurop athy, 8.5% progressive lumbosacral polyradiculopathy, and 8.5% myopath y. Half of the patients exhibited previous or concomitant signs of cen tral nervous system involvement and 18 patients died during the study period. CIDP and cranial neuropathies usually appeared early in the co urse of the disease and consequently showed neurological improvement. Nerve conduction studies of DDI related toxic neuropathies showed dist al axono-myelinic sensitive-motor neuropathy, differing from CIDP by t he absence of a conduction block. Distal symmetric polyneuropathies, f requent in the advanced systemic illness, do not systematically requir e an extended workup, but more unusual peripheral neuropathies which m ight be treatable necessitate further investigations (electromyography , radiology, serological blood tests; protein chemistry and routine wo rkup of the cerebrospinal fluid). For example, progressive lumbosacral polyradiculopathies responded to early treatment, with a better outco me in one case of herpetic origin than in another case due to cytomega lovirus infection. Our observations suggest that myopathies in HIV inf ected patients should first be tackled by temporary interruption of vi rostatic medication, followed by muscle biopsy if the symptoms persist .