Human immunodeficiency virus–associated polymyositis: A longitudinal study of outcome

• Published in: Arthritis and rheumatism Vol. 49; no. 2; pp. 172 - 178
• Main Authors: Johnson, Randall W., Williams, Francis M., Kazi, Salahuddin, Dimachkie, Mazen M., Reveille, John D.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 15.04.2003
• Subjects: Adult; Aged; Anti-HIV Agents - administration & dosage; Anti-Inflammatory Agents - administration & dosage; Biopsy; CD4-CD8 Ratio; Creatine Kinase - blood; Electromyography; Female; HIV infection; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - drug therapy; Humans; Longitudinal Studies; Male; Middle Aged; Muscle Weakness - drug therapy; Muscle Weakness - pathology; Muscle Weakness - virology; Polymyositis; Polymyositis - drug therapy; Polymyositis - pathology; Polymyositis - virology; Prednisolone - administration & dosage; Prognosis; Prospective Studies; Treatment Outcome
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.11002

Objective To determine the clinical course and optimum treatment of human immunodeficiency virus (HIV)–associated myositis. Methods Sixty‐four patients attending a county outpatient HIV/acquired immunodeficiency syndrome facility were referred for the presence of elevated creatine kinase (CK) levels or muscle weakness. Patients underwent neurologic and rheumatologic evaluation, electromyography, and muscle biopsy after exclusion for recreational drug or alcohol use, metabolic/endocrine disorders, zidovudine therapy, and other infections. Results Thirteen patients (20%) had biopsy‐proven myositis. The median duration of HIV infection prior to diagnosis of myositis was 4.3 years (range 0–11 years). Six patients had concomitant diffuse infiltrative lymphocytosis syndrome. There was no correlation of severity of weakness, stage of HIV infection, or retroviral treatment with the CK level at diagnosis. Eight patients received prednisone (60 mg/day) with 5 attaining complete resolution of myositis. The remaining 3 patients received immunosuppressive therapy (azathioprine or methotrexate and intravenous immunoglobulin) and had normalization of strength and CK. Four patients had spontaneous resolution of their myositis without treatment. Conclusion HIV‐associated myositis occurs at any stage of HIV infection, has a relatively good prognosis, responds well to immunosuppressive therapy, and has little evidence of adverse outcome on the HIV infection.