The last answer I read on this subject was from August of 2005. I too have an undetectable VL and a cd4 count over 500. I have been tested for any other cause of my myelopathy and there are no other causes. I also had several LP's including several that did not close for over 90 days. Is there any more information for those of us stuck on pain killers for years living with Myelopathy and HIV. I just keep hearing "sometimes that happens" Is there any line of Treatment?

You don't mention which HIV meds you are taking or what is your treatment and HIV history. HIV myelopathy is unusual in persons with suppressed viral levels and CD4 count > 500. Old myelopathy may continue to cause problems and symptoms despite good response to HIV treatment; Many other conditions can mimic HIV myelopathy so precise diagnosis can be tough due to overlapping characteristics and inadequate clues from a thorough work up (often involves consultation with HIV experienced neurologist and neuroradiologist). See below for differential diagnostic possibilities (from www.hivmedicine.com):

Table 5: Differential diagnoses of HIV myelopathy and diagnostic workup condition adequate diagnostic step (commentary) Mechanic compresssion of the myelon (cervical myelopathy, disk herniation) degenerative changes of the cervical spine MRI shows reduced CSF spaces around the spinal cord with hyperintense lesions of the cord parenchyma Neurosyphilis Antibody testing and CSF analysis (pleocytosis >45/3) (serological findings may be atypical for active neurosyphilis) CMV myelopathy CSF (signs of inflammation) PCR for CMV in CSF antibody testing in blood and CSF (IgG and antibody index may be increased) Toxoplasmosis contrast enhancing cord lesion on MRI VZV myelitis CSF (marked inflammatory signs) VZV specific IgG in blood and CSF (IgM may be absent) VZV PCR in CSF Mostly antecedent or accompanying cutaneous zoster lesions HSV myelitis CSF (inflammatory signs may be absent), HSV PCR in CSF HTLV-1 (tropical spastic paraparesis) travel to the Carribean, West Africa or East Asia slow evolution of symptoms, bladder dysfunction characteristic, CSF inflammation, HTLV-1 specific antibodies Severe combined degeneration Vitamin B12 levels, increased erythrocyte volume heredo-degenerative diseases (hereditary spastic paraparesis, adrenoleukodystrophy, Friedreich ataxia etc.) appropriate tests

Often very frustrating situation for patients as you describe. KH