HIV Infection May Trigger Neurologic Disorder

A disorder similar to amyotrophic lateral sclerosis (ALS) has been associated with HIV-1 infection, prompting the suggestion that viral infection might precipitate the disorder in some people. In a retrospective study of 1,700 patients with HIV infection and neurological symptoms seen between 1987 and 2000, Dr. Antoine Moulignier of the Foundation Adolphe de Rothschild in Paris and his colleagues identified six patients who met international criteria for definite, probable or possible ALS. The incidence of the disorder was 3.5 per 1,000, well above the expected incidence in the general population of 0.4 to 1.76 per 100,000 (Neurology 57 [6]:995-1001, 2001).

The ALS-like syndrome was the first manifestation of HIV-1 in all of the patients. Presenting symptoms included tongue fasciculations and distal motor weakness in one or more limbs and initially were reminiscent of those of monomelic amyotrophy. However, the rapid progression of symptoms and the young age of the patients indicated that the disorder was a variant of ALS, rather than the classic disease.

In an accompanying case report, Dr. D.J.L. MacGowan and associates at Beth Israel Medical Center in New York described a 32-year old woman who presented with a rapidly progressing ALS-like syndrome and was found to be HIV-positive (Neurology 57 [6]:1094-97, 2001). Multidrug cocktails and improved control of HIV-1 viral load have made the disorder less common, Moulignier and his associates said. All seven patients improved or stabilized transiently following treatment with zidovudine, another nucleoside analogue, or active antiretroviral therapy. In an editorial, Dr. Burk Jubelt and Dr. Joeseph R. Berger said that viral causes should be considered in patients presenting with the classic clinical signs of ALS "because HIV-ALS syndromes are treatable" (Neurology 57 [6]:945-46, 2001).

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