Background/Purpose: Different myopathies can be observed in HIV-infected patients, such as idiopathic inflammatory myopathies (inclusion-body myositis or polymyositis) or toxic mitochondrial myopathies secondary to antiretroviral therapy. The frequency and the evolution of those different myopathies is not precisely known, thus we aimed to describe all HIV patients from our center who presented a myopathy.  

Methods: We conducted a systematic review of computerised database of the department of pathology to select HIV infected patients who underwent a muscle biopsy during the 2005-2011 periods. For each biopsies, morphological (hematein eosin staining), mitochondrial (Gomori trichrome, succinic dehydrogenase and cytochrome oxidase staining) and immunological (HLA1, lymphocytes subclasses staining) analyses were performed.

Results: During the studied period, 2880 muscle biopsies were performed. Fifty biopsies (1.7%) were realised in 45 HIV+ patients (mean age: 50.1 years [39-61,2]).

Among the 50 biopsies, 43 were abnormal. The most frequently observed myopathy was polymyositis (60%). Among pathologicaly diagnosed polymyositis during this period of time (n=161), 23 (14%) were diagnosed in HIV+ patients. After polymyositis, mitochondrial abnormalities were the most frequently observed lesions (54%, myositis and mitochondrial abnormalities beeing observed concomitantly in some patients). Five cases (13%) of inclusion body myositis were also pathologically diagnosed.

Compared to a cohort of 50 anti-synthetase syndrome patients (with anti-Jo1 Abs), HIV polymyositis patients had a less severe weakness (MRC manual testing ≥ 4/5 83% in HIV+  vs. 54% for Jo1+ patients p<0.05) and lower CK levels (1677 vs. 4975 IU/L, p<0.05). Muscle weakness disappeared within six months after steroid treatments and/or highly active antiretroviral therapy introduction or modification. HIV viral load was detectable (125.186±21.295 copies/ml) for 80% of polymyositis patients whereas it was undetectable for all patients with isolated mitochondrial abnormalities (p<0.01). For the 7 patients with isolated mitochondrial abnormalities (suggesting mitochondrial toxicity), nucleoside-analogue reverse-transcriptase inhibitors were stopped for another highly active antiretroviral therapy combination, in the frame of an interventional study (the Myotox trial). Two years latter, no significant change concerning either muscular symptoms, CK level or pathological features of mitochondrial abnormalities were observed after this intervention.

Conclusion: This retrospective study showed that polymyositis is the most frequent HIV associated myopathy, and suggested that a HIV test must be proposed to every patient presenting a polymyositis. Polymyositis in HIV patients seemed not severe, and is associated with uncontrolled HIV replication. HIV patients with isolated mitochondriopathy did not improve after nucleoside-analogue reverse-transcriptase inhibitors withdrawal.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/polymyositis-in-hiv-patients-is-associated-to-uncontrolled-viral-load/