Monday September 27, 2001

Lou Gehrig's Symptoms Seen in People with HIV

By Merritt McKinney


NEW YORK (Reuters Health) - Two teams of scientists report that HIV, the virus that causes AIDS, may trigger cases of a neurological disorder similar to amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.

Unlike normal ALS, which is always fatal, symptoms of the HIV-related neurological disorder stopped progressing or improved once patients began therapy to treat HIV.

The findings suggest that viral infections may be to blame for some cases of ALS, researchers say.

``This is exciting news, because if this form of ALS caused by HIV is treatable, then other forms of ALS may be treatable as well,'' according to Dr. Burk Jubelt of the State University of New York Upstate Medical University in Syracuse.

Jubelt, a co-author of an editorial accompanying the new reports, added in a press release, ``But more research needs to be done to confirm these results and determine whether there are other viral causes of ALS.''

ALS is a slowly progressing, fatal disease for which there is currently no treatment. The disease causes progressive muscle weakness. After a few years, a person with ALS develops difficulty speaking, swallowing and breathing.

In a review of 1,700 HIV patients treated during a 13-year period, French researchers identified six individuals who showed signs of an ALS-like disease. The percentage of patients who had this disorder was considerably higher than the percentage of the general population that has ALS.

Dr. Antoine Moulignier, of the Foundation Adolphe de Rothschild in Paris, and colleagues were able to rule out other potential causes of the disorder besides HIV.

The symptoms appeared similar to the signs of ALS, but there were several noticeable differences, the investigators report in the September 25th issue of the journal Neurology.

The progression of symptoms, occurring over a few weeks, was much more rapid than is typical for ALS, which normally takes months or years to advance. The HIV-positive patients, averaging 34 years old, were also much younger than the typical ALS patient. ALS commonly strikes between ages 55 and 60.

And unlike ordinary ALS, which is untreatable, the HIV-related ALS-like symptoms improved in some patients after they started taking anti-HIV drugs.

Five of the six patients were treated before the introduction of powerful drugs called protease inhibitors. Since widespread use of these drugs began, Moulignier's team has not seen any HIV-positive patients who have developed the ALS-like syndrome.

In a second report in Neurology, Dr. Daniel J. L. MacGowan of Beth Israel Medical Center in New York and colleagues document the case of a 32-year-old HIV-positive woman who developed an ALS-like syndrome. Once the woman began taking combination therapy, including a protease inhibitor, her ALS-like symptoms disappeared within a year. Four years after starting treatment, the woman remains free of ALS-like symptoms.

The reports of an ALS-like disorder in people with HIV suggests that some cases of ALS may be caused by a virus, according to Jubelt and his co-author, Dr. Joseph R. Berger of the University of Kentucky Medical Center in Lexington.

The editorialists conclude that ``when a patient presents with the classic clinical signs of ALS, a viral cause should also be considered because HIV-ALS syndromes are treatable.''