|Elevated CK -- what gives?
Jul 7, 2000
I'm seeing elevated CK levels in a large number of my patients who aren't on AZT. While I know AZT can cause myopathy, I haven't seen indications that other meds can cause it, and Medline and AIDSline searches suggest that HIV-caused myopathy doesn't really happen (i.e., the HIV-associated myopathy is really AZT-associated myopathy). I ran CK-MB isoenzyme on one patient and it was normal, so it's probably not heart, and there's nothing to suggest it's brain, so that leaves muscle. I'm assuming this is a drug effect, but I'm not sure of that. Any thoughts? Forgive me for asking so technical a question; The Lancet suggested you like questions from docs too.
Response from Dr. Henry
There is an HIV associated myopathy (JAMA 1986; 256: 2381-2383; Neurology 1993; 43: 971-976; Clin Neuropathol 1996; 15: 221-225). Although ZDV has been the NRTI most associated with drug-related myopathy, it can occur with other NRTIs (i.e. D4T, ddC) possibly through toxicity to mitochondria. Heavy exercise, IM injections (i.e. testosterone), over-heating can result in CK elevations. If one of the NRTIs is involved it may be a good idea to check for other signs of possible mitochondrial dysfunction (i.e. high resting lactate levels, electrolyte abnormalities, elevated liver enzymes). A muscle biopsy can sometimes identify toxic myopathy from drugs (i.e. ragged red fibers on microscopy). Keith Henry, M.D.
Can you help
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.