What is the relationship between Human Immunodeficiency Virus (HIV) and myopathy?

From the Guidelines

HIV myopathy should be managed by optimizing antiretroviral therapy, considering alternative medications if the condition is drug-related, and providing supportive care such as physical therapy, nutritional support, and pain management, as the risk of myopathy may be increased in patients with HIV infection due to the use of other potentially myotoxic drugs or agents that can inhibit the metabolism of statins 1. When managing HIV myopathy, it is crucial to consider the potential causes, including direct infection of muscle tissue by the HIV virus, side effects of antiretroviral medications like zidovudine, or inflammatory processes triggered by the immune system's response to HIV.

• Key aspects of management include:
  • Optimizing antiretroviral therapy to achieve viral suppression, which can improve myopathy symptoms
  • Switching from potentially myotoxic medications like zidovudine to alternative antiretroviral drugs if necessary
  • Implementing physical therapy and exercise programs to maintain muscle strength and function
  • Providing nutritional support to prevent malnutrition, which can exacerbate muscle wasting
  • Managing pain with non-steroidal anti-inflammatory drugs or other analgesics as needed
  • Considering corticosteroids for inflammatory myopathies, with cautious use in immunocompromised patients The risk of myopathy in HIV-infected patients can be increased due to factors such as the use of other potentially myotoxic drugs or agents that inhibit statin metabolism, as noted in the guidelines for managing dyslipidemia in HIV-infected adults receiving antiretroviral therapy 1.
• Important considerations in preventing and managing myopathy include:
  • Avoiding combination fibrate-statin therapy unless absolutely necessary, due to the increased risk of myopathy
  • Preferably using pravastatin or fluvastatin when combination therapy with fibrates is required
  • Regularly monitoring muscle strength, creatine kinase levels, and functional status to track the condition's progression and response to treatment Early diagnosis and intervention are critical to preventing permanent muscle damage and maintaining quality of life in patients with HIV myopathy.

From the Research

HIV Myopathy

• HIV myopathy can occur at any stage of HIV infection 2
• It is characterized by symmetrical weakness of the proximal muscles in the extremities, and serum creatine kinase levels are often moderately elevated 2
• The clinical manifestations of HIV myopathy can be similar to those of other conditions, such as zidovudine myopathy, HIV wasting syndrome, and opportunistic infections or tumoral infiltrations of muscle 3

Types of HIV Myopathy

• HIV-associated myopathies: can occur at any stage of HIV infection, and have a relatively good prognosis 4
• Zidovudine myopathy: caused by long-term therapy with zidovudine, and is characterized by toxic mitochondrial myopathy and inflammatory myopathy 5, 6
• HIV wasting syndrome: a condition characterized by weight loss, muscle wasting, and weakness, often occurring in the late stages of HIV infection 3

Diagnosis and Treatment

• Diagnosis of HIV myopathy can be made using electromyography, muscle biopsy, and immunohistology for major histocompatibility complex class I antigen 5, 3
• Treatment of HIV myopathy includes corticosteroids, nonsteroidal anti-inflammatory agents, and intravenous immunoglobulin 4, 2
• Zidovudine myopathy can be treated by discontinuing zidovudine therapy, and in some cases, prednisone or nonsteroidal anti-inflammatory drugs may be effective 5, 6