Satin Zachary Aaron, Bayat Elham
George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Department of Neurology, George Washington University Medical Faculty Associates, Washington, District of Columbia, USA.
Case Rep Neurol. 2021 Jan 28;13(1):59-64. doi: 10.1159/000511203. eCollection 2021 Jan-Apr.
There appears to be a relationship between retroviruses such as HIV and the development of an ALS-like syndrome. Few cases have been reported; however, there exists evidence of a higher frequency of motor neuron disease in HIV-infected patients, as well as potential slowing and reversibility of disease course with combination antiretroviral therapy. We conducted a retrospective chart review of patients presenting to the George Washington University ALS Clinic from September 2006 to June 2018 to identify patients with HIV receiving HAART who were subsequently diagnosed with ALS or an ALS-like disorder. Our goals were to describe our patients' disease course and compare them to general characteristics of ALS. We report three cases of HIV-positive individuals, all male, who were subsequently diagnosed with ALS. Each presented with symptoms of limb onset ALS with involvement of upper and lower motor neurons and whose disease originated at the cervical level. All three had been diagnosed with HIV prior to presentation and were presumably compliant with antiretroviral therapy throughout. Our patients demonstrated effective control of their HIV infection. Each experienced relatively slow progression of motor impairment compared to general ALS characteristics. Our study offers a distinct profile of HIV-positive patients compliant with HAART subsequently diagnosed with an ALS-like disorder. Further study should aim to uncover pathophysiological similarities between motor neuron disease both in the presence and absence of retroviral infection and to develop effective medical therapy for each.
诸如人类免疫缺陷病毒（HIV）之类的逆转录病毒与肌萎缩侧索硬化症（ALS）样综合征的发展之间似乎存在某种关联。虽然仅有少数病例被报道；然而，有证据表明HIV感染患者中运动神经元疾病的发生率更高，而且联合抗逆转录病毒疗法可能会减缓疾病进程并使其具有可逆性。我们对2006年9月至2018年6月期间到乔治·华盛顿大学ALS诊所就诊的患者进行了一项回顾性病历审查，以确定接受高效抗逆转录病毒治疗（HAART）且随后被诊断为ALS或ALS样疾病的HIV患者。我们的目标是描述我们患者的疾病进程，并将他们与ALS的一般特征进行比较。我们报告了三例HIV阳性个体，均为男性，他们随后被诊断为ALS。每个人都表现出肢体起病的ALS症状，同时累及上下运动神经元，且其疾病起源于颈椎水平。所有三人在就诊前均已被诊断出感染HIV，并且据推测自始至终都坚持抗逆转录病毒治疗。我们的患者显示出对HIV感染的有效控制。与一般ALS特征相比，每个人的运动功能障碍进展相对较慢。我们的研究提供了符合HAART治疗且随后被诊断为ALS样疾病的HIV阳性患者的独特情况。进一步的研究应旨在揭示存在和不存在逆转录病毒感染时运动神经元疾病之间的病理生理相似性，并为每种疾病开发有效的药物治疗方法。
