Myopathy with human immunodeficiency virus type 1 (HIV-1) infection: HIV-1 or zidovudine?

Article Abstract:

The drug zidovudine has been shown to delay the progression of disease in patients infected with the human immunodeficiency virus (HIV) and who have less than 500 cells per cubic millimeter of CD4, a type of immune cell. These patients often require long-term treatment with zidovudine and may develop complications such as muscle disease (myopathy). One study showed that 14 out of 86 HIV-infected patients had persistent increases in levels of the muscle enzyme creatine kinase, indicating muscle damage. Five of these patients who were treated with zidovudine for 45 weeks developed muscle pain and weakness. This resolved in four patients after discontinuation of the drug. Examination of muscle tissue revealed abnormal changes, but no evidence of inflammation. Other studies have shown that myopathy can occur in HIV-infected patients who are not treated with zidovudine. These patients develop muscle weakness, atrophy of muscle tissue, and elevated creatine kinase levels. Myopathy may be an initial symptom of HIV infection, or may develop after an opportunistic infection. Although anti-inflammatory agents improve symptoms, myopathy rarely resolves spontaneously. Examination of muscle tissue from HIV-infected patients with myopathy who have not been treated with zidovudine revealed various abnormalities and inflammation. The mechanism of HIV-related myopathy may involve an immune process. Although inflammation is more evident in the muscle of patients with HIV-related myopathy, zidovudine is partially responsible for the development of inflammation. Zidovudine-related myopathy is consistently associated with the presence of abnormal mitochondria, the energy producing component of the cell, and often resolves after the withdrawal of the drug. When considering treatment with zidovudine, HIV-infected patients should be screened for myopathy by routine measurement of creatine kinase levels and, possibly, muscle biopsy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Zidovudine, Muscle diseases, Muscular diseases, editorial

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Alternating drug regimens to treat HIV infection

Article Abstract:

Switching HIV patients between two different groups of AIDS drugs every three months may prevent the virus from becoming resistant to any particular drug, according to a study of 161 HIV patients. AIDS drugs are no longer effective if the virus can resist their effects. At that point, the patient would have to switch to another drug.

Prevention, Drug resistance in microorganisms, Microbial drug resistance

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Should we treat acute HIV infection?

Article Abstract:

Many doctors believe HIV patients should begin taking anti-HIV drugs as soon as they are diagnosed. This might suppress the virus before it can impact the immune system and may reduce the risk of drug resistance developing.

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