Neuro, muscular and skeletal problems of HIV

The 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 manifest as body and joint pains, abnormal sensations and neurological problems.Some of these problems are directly caused by the human immune deficiency virus. Due to immune deficiency, one becomes more prone to acquire various infections including that of the muscles, brain and spinal cord. Some neurological problems occur due to the drugs taken. Body ache is the commonest symptom of HIV infection occurring in about 45 per cent of cases. It is intermittent and involves many joints. Loss of appetite, cachexia and recurrent infections also contribute to the body ache. Similarly recurrent and chronic fever also causes much body pain in these individuals. HIV may directly involve joints mainly knees and ankles. There may be no significant abnormality found in X-rays of the affected joints. 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. They are more prone to develop sexually transmitted disease like gonorrhea, Chlamydia infections, e.t.c. In that case along with urethral discharge and dysurea, they also suffer from joint pain. Arthritis may be 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 aggravate this condition. About 10 to 15 per cent patients on antiretroviral therapy also develop osteoporosis. Muscular pains 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, muscles of the shoulders and thighs are involved. This causes difficulty in activities like combing or climbing stairs. Bacterial infection of the muscles can also occur. Vasculitis, i.e. inflammation of blood vessels like polyateritis nodosa, giant cell arteritis e.t.c. has 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 be caused by the antiretroviral drug Zidovudine. These muscle and joint problems can be relieved 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 liking for nervous system. Therefore it causes a wide spectrum of neurological disorders. Peripheral neuropathy can 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. Primary tumors in the brain like primary CNS lymphomas and other tumours can cause various neurological abnormalities like paralysis, seizures, unconsciousness and coma in various degrees. Degeneration of the white matter of the brain can also occur due to HIV infection which can manifest as disorientation, unconsciousness, e.t.c. neurological problems. 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 cause insomnia, depression, dizziness and other neurological symptoms. Infections of the nervous system in case of HIV patients are curable in early stages, i.e. before any damage to the nervous system occurs. 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.