ALS-like Symptoms in HIV-infected Patients Reversed by Retroviral Therapies

Researchers have suspected retroviruses to play a role in amyotrophic
lateral sclerosis (ALS) since the 1960s, when poliomyelitis was proposed to
contribute to progression of the disease. Through the ’80s and ’90s, ALS syndromes
associated with retroviral infection have been reported, though a direct correlation
between the two has been lacking. In last month’s Neurology, papers by Moulignier
et al. and MacGowan et al. describe seven new cases of ALS-like symptoms in
patients infected with HIV. Interestingly, the ALS symptoms responded to retroviral
therapy.

MacGowan et al. report a patient, positive for HIV, who had rapidly progressing
ALS-like symptoms. The ALS functional rating score dropped from 34/40 at the
initial visit, to 13/40 three weeks later, at which time the patient was in
a quadriplegic state. She was started on antiretroviral therapy and within
six months could again walk with assistance; four years later she has almost
fully recovered, with an ALS functional rating of 40/40.

Moulignier et al. identified six HIV-infected patients with ALS-like symptoms,
from approximately 1,700 referrals over a 13 year period. The ALS symptoms improved
in all patients under antiretroviral therapy, though in two cases symptoms
reappeared when therapy failed. In two patients ALS symptoms completely disappeared.

“These data validate the idea that ALS-like symptoms seen in such cases are
a consequence of HIV infection and suggest, as the authors point out, that an
overactivated immune system may have an effect on motor neurons similar to
classical ALS,” notes Harvey Cantor, of the Dana-Farber Cancer Institute.

Reference:MacGowan DJ, Scelsa SN, Waldron M. An ALS-like syndrome with new HIV infection and complete
response to antiretroviral therapy. Neurology (57):1094-1097. Abstract

Moulignier A, Moulonguet A, Pialoux G, Rozenbaum W. Reversible ALS-like disorder in HIV infection. Neurology
(57): 995-1001. Abstract


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