HIV and Neuromusculoskeletal Problems

Janet (fictious name ), a HIV affected teenager, started having pain in the knees and stiffness, which made walking difficult. All the tests done, revealed no specific abnormality. She was diagnosed to be suffering from myopathy due to HIV. After physiotherapy and treatment, today she is able to do her routine work very well. Human immune deficiency virus is well known to produce asthenia and infections of various kinds. But it also produces various affections of the nervous and musculo - skeletal system which make the affected person suffer from body ache, joint pains and parasthesias and other neurological problems of various kinds. Some of these problems are directly caused by the human immune deficiency virus. Some of the associated infections also produce various problems of joints and muscles, while some of the problems are related to the treatment of HIV. Arthralgia or body ache is the commonest symptom of HIV infection occurring in about 45% cases. It is intermittent and mild usually generalized involving many joints. It occurs in advanced immune deficiency. Loss of appetite, cachexia and recurrent infections also contribute to it. Similarly high persistent fever due to many reasons also causes much body pain in these individuals. Sometimes the person may suffer from acute joint pains which may subside spontaneously after 24 hours. HIV may directly involve joints mainly knees and ankles. There may be no significant abnormality found in X-rays of the affected joints. Treatment includes anti-inflammatory drugs, either steroidal or non steroidal. Another kind of peripheral arthritis affecting the lower limbs can occur in HIV positive individuals. There may be associated dryness of eyes, skin and genital lesions. The patient may get relief from anti-inflammatory drugs. Apart from these, an immune depressed person is also prone to develop joint pain and inflammation due to the various infections. Any joint can be involved by infection caused by bacteria producing septic arthritis. This will cause severe pain and swelling of the joint usually with high fever. These immune depressed patients are more prone to develop sexually transmitted disease like gonorrhea both because of the behavior pattern and increased susceptibility to acquire infections. In that case along with urethral discharge and dysurea, they also suffer from joint pain. Arthritis is also associated with psoriasis, a kind of dermatitis to which HIV positive patients are more prone. Osteonecrosis a condition of softening or degeneration of bones may occur in HIV positive individuals, affecting the knees and hip joints frequently. Affected individual suffers from much pain in the joints, difficulty in walking and may have spontaneous fractures at times, further aggravating the pain. Other factors like prolonged steroid therapy and alcoholism may also contribute to this condition. About 10 to 15% patients on antiretroviral therapy also develop osteoporosis. Various muscular pains, myalgias and fibromyalgia, (muscular pain due to mental tension and depression) also occur regularly in immune depressed individuals. Polymyositis i.e. inflammation of groups of muscles can occur early in the course of HIV infection. Typically proximal group of muscles are affected, that is of the shoulders and thighs. This causes difficulty in activities like combing or climbing stairs. Similar to septic arthritis bacterial infection of the muscles may occur, which is called as polymyositis. Vasculitis, i.e. inflammation of blood vessels like polyateritis nodosa, giant cell arteritis e.t.c. have also been described with HIV infection. In these disorders a person typically has complaints of pain in multiple small joints. Myopathy i.e. affection of muscles can also be caused by the antiretroviral drug Zidovudine. These muscle and joint problems can be cured temporarily by pain killers. Those occurring due to infections resolve completely with suitable anti infectious agents. Physiotherapy is also useful. But recurrences do occur, causing much discomfort. The human immune deficiency virus has a predilection for nervous system. Therefore it causes a wide spectrum of neurological disorders. As in diabetes, peripheral neuropathy can also be caused by the HIV infection. This causes burning pain and various kinds of abnormal sensations in the feet, ankles and also hands. Antiretroviral drug stavudine also produces peripheral neuropathy. There may be primary tumors in the brain like primary CNS lymphomas and other tumours which can cause various neurological abnormalities like paralysis, seizures, unconsciousness and coma in various degrees depending on the part of brain affected. Degeneration of the white matter of the brain can also occur. Primary HIV encephalopathy i.e. disorientation, unconsciousness, e.t.c. neurological problems occurring due to HIV infection are also not uncommon. Apart from this, various opportunistic infections like toxoplasmosis, syphilis, herpes simplex and other viruses, tuberculosis, e.t.c. can affect the brain causing neurological problems. Drugs like Efavirenz can also cause insomnia, depression, dizziness and other neurological symptoms. The infections of the nervous system in case of HIV patients are curable in early stages, i.e. before any damage to the nervous system. But the tumours and peripheral neuropathy are irreversible conditions and only palliative treatment i.e. treatment to provide some relief is possible. A good nutritious diet containing iron, necessary vitamins, calcium and other nutrients is very beneficial to keep the person comfortable in the face of these problems. Regular exercise will also help him overcome the stiffness in case of muscle and joint involvement. There is no reason why a HIV positive individual cannot have a good quality of life in spite of these problems. Only thing required is reporting the symptoms early and good adherence to the therapy as prescribed. E-mail – rachna212002@yahoo.co.uk