AIDS. 2004 Jul 2;18(10):1403-12. doi: 10.1097/01.aids.0000131309.70451.fe.
To investigate progressive, severe neuromuscular weakness associated with lactic acidosis in some HIV-infected patients after exposure to nucleoside reverse transcriptase inhibitors (NRTI).
HIV-associated neuromuscular weakness syndrome (HANWS) was retrospectively identified and classified based on the level of diagnostic certainty: possible (progressive weakness owing to neuromuscular disease), probable (progressive neuromuscular weakness with documented exclusion of confounding causes), or definite (progressive weakness and electrophysiological or pathological evidence of neuromuscular pathology).
Of 69 patients identified with HANWS, 27 had definite HANWS, 19 probable, and 23 possible. In 44 patients with documented follow-up, 16 required intubation and nine died. There was a marginal association between death and hyperlactatemia (P = 0.061). At onset of neurological symptoms, 68 were receiving antiretroviral therapy, including stavudine for 61 (89.7%). Serum lactate level was elevated (> 2.2 mmol/l) in 30/37 (81%), with a trend towards an association between hyperlactatemia and stavudine usage (P = 0.087). In 25, neurological symptoms occurred after antiretroviral therapy discontinuation (median, 14 days). Electrophysiological studies (n = 24) indicated sensorimotor neuropathy in 20 patients and myopathy in three. Nerve biopsy (n = 9) revealed axonal degeneration and inflammation in three, mixed axonal and demyelinating lesions in three, and primary axonal neuropathy in three. Of 15 muscle biopsies, three revealed inflammation and four mitochondrial abnormalities.
A severe neuromuscular weakness syndrome may occur in HIV-infected individuals. The association with hyperlactatemia and NRTI exposure supports mitochondrial toxicity as a pathogenesis. In some, the onset of neurological symptoms lagged significantly after discontinuation of antiretroviral therapy, suggesting that different etiological mechanisms may underlie these cases.
调查部分感染人类免疫缺陷病毒（HIV）的患者在接触核苷类逆转录酶抑制剂（NRTI）后出现的进行性严重神经肌肉无力及乳酸酸中毒情况。
对HIV相关神经肌肉无力综合征（HANWS）进行回顾性鉴定，并根据诊断确定性水平进行分类：可能（因神经肌肉疾病导致的进行性无力）、很可能（进行性神经肌肉无力且已排除混杂病因）或确诊（进行性无力以及神经肌肉病变的电生理或病理证据）。
在确诊为HANWS的69例患者中，27例为确诊HANWS，19例为很可能，23例为可能。在有记录随访的44例患者中，16例需要插管，9例死亡。死亡与高乳酸血症之间存在微弱关联（P = 0.061）。在出现神经症状时，68例正在接受抗逆转录病毒治疗，其中61例（89.7%）使用司他夫定。37例中有30例（81%）血清乳酸水平升高（> 2.2 mmol/L），高乳酸血症与司他夫定使用之间存在关联趋势（P = 0.087）。25例患者在停用抗逆转录病毒治疗后出现神经症状（中位时间为14天）。电生理研究（n = 24）显示，20例患者存在感觉运动神经病变，3例存在肌病。神经活检（n = 9）显示，3例存在轴突变性和炎症，3例存在轴突和脱髓鞘混合性病变，3例存在原发性轴索性神经病变。15例肌肉活检中，3例显示炎症，4例显示线粒体异常。
HIV感染个体可能会出现严重的神经肌肉无力综合征。与高乳酸血症及接触NRTI的关联支持线粒体毒性作为发病机制。在部分患者中，神经症状在停用抗逆转录病毒治疗后显著延迟出现，提示这些病例可能存在不同的病因机制。
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