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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.

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