In situ detection of polymerase chain reaction-amplified HIV-1 nucleic acids in skeletal muscle in patients with myopathy.

The purpose of this study was to determine if the myopathy that commonly occurs in patients with AIDS is associated with active HIV-1 infection in the muscle tissues. Seven muscle biopsies from patients infected by HIV-1 and six controls were tested for HIV-1 DNA and RNA using polymerase chain reaction in situ hybridization and reverse transcriptase in situ polymerase chain reaction. HIV-1 DNA was detected in rare cells in only one case by standard in situ hybridization. However, after polymerase chain reaction amplification HIV-1 DNA was detected in many cells in four of seven muscle tissues from patients with the viral infection and in none of the controls. The number of cells with detectable provirus in the tissue positive by standard in situ hybridization increased up to 100-fold after amplification. Most of the HIV-1 infected cells were macrophages, as determined by colabeling experiments that were localized mainly in the areas of myocyte necrosis. Myocyte nuclei that contained amplified HIV-1 nucleic acids were also noted. Most virally infected cells contained HIV-1 transcripts, which is consistent with activated infection. The demonstration of many HIV-1 infected macrophages and myocytes in muscle biopsies from HIV-1 infected patients with myopathy suggests that active viral infection may play a role in the clinical disease state.