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Expanding the spectrum of HIV-associated myopathy
  1. Océane Landon-Cardinal1,
  2. Laure Gallay2,
  3. Odile Dubourg3,
  4. Thierry Maisonobe3,
  5. Sarah Léonard-Louis3,
  6. Dalila Beniken4,
  7. Anne Simon1,
  8. Anthony Behin5,
  9. Tanya Stojkovic6,
  10. Charles Duyckaerts7,
  11. Guillaume Breton1,
  12. Aude Rigolet1,
  13. Olivier Fain8,
  14. Marie-Caroline Meyohas9,
  15. Catherine Leport10,11,
  16. Marc-Antoine Valantin12,
  17. Daniel Vittecoq13,
  18. Jean-François Bergmann14,
  19. Thomas Hanslik15,
  20. Marie-Paule Chauveheid16,
  21. Zahir Amoura17,
  22. Thomas de Broucker18,
  23. Bruno Eymard5,
  24. Nausicaa Beaudequin1,
  25. Olivier Benveniste1,
  26. Yves Allenbach1
  1. 1Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
  2. 2Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Claude Bernard, Lyon, France
  3. 3Département de Neuropathologie, Sorbonne Université Pierre, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  4. 4Service de Maladie Infectieuse, Hôpital Pitié-Salpêtrière, Paris, France
  5. 5Paris-Est Neuromuscular Center, APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
  6. 6Paris-Est Neuromuscular Center, Neuromuscular Disease Centre, Hôpital de la Pitié-Salpétrière, APHP, Paris, France
  7. 7Département de Neuropathologie Raymond Escourolle, GH Pitié-Salpêtrière, Faculté de médecine Sorbonne Université, Paris, France
  8. 8Médecine Interne, APHP, DHUi2B, Centre de Référence associé sur les angiœdèmes à kinines, Hôpital Saint-Antoine, Université Paris 6, Paris, France
  9. 9AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
  10. 10IAME, UMR 1137, Inserm, université Paris Diderot, Sorbonne Paris Cité, Paris, France
  11. 11Mission COREB nationale, Assistance publique-Hôpitaux de Paris, Paris, France
  12. 12Service de Maladie Infectieuse et Tropicales, APHP, Hôpital Pitié-Salpêtrière, Paris, France
  13. 13Department of Infectious and Tropical Diseases, AP-HP Bicetre hospital, Le-Kremlin-Bicêtre, France
  14. 14Médecine Interne, APHP, Hôpital Lariboisière, Service de Médecine Interne, Paris, France
  15. 15Médecine Interne, Hôpital Ambroise Paré, service de médecine interne, Paris, France
  16. 16Department of Internal Medicine, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
  17. 17Department of Internal Medicine 2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
  18. 18Service de Neurologie, Centre Hospitalier de Saint-Denis, Paris, France
  1. Correspondence to Dr Océane Landon-Cardinal, Sorbonne Université, University Pierre et Marie et Curie, Department of Internal Medicine and Clinical Immunology, APHP, Hôpital Pitié-Salpêtrière, Paris 75651, France; o.landoncardinal{at}gmail.com

https://doi.org/10.1136/jnnp-2018-319419

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    Introduction

    Myalgia or muscle weakness is frequently observed during HIV infection (1), and 15% of HIV patients may have an increased serum creatine kinase (CK) level.1 Case reports or case series have suggested that HIV-associated myopathies represent a large spectrum of disease.2

    To date, data on muscle involvement during HIV infection remain sparse and we aimed to describe the clinical characteristics and evolution of biopsy-proven HIV-associated myopathies.

    Methods

    All HIV-positive patients who had a muscle biopsy performed at the Pitié-Salpêtrière University Hospital between 2001 and 2012 were identified.

    Medical records were retrospectively reviewed to assess muscle disease features and HIV infection characteristics. Patients were classified histologically as polymyositis (PM), non-specific myositis (NSM), immune-mediated necrotizing myopathy (IMNM), or inclusion body myositis (IBM) according to the European Neuromuscular Center (ENMC) criteria.3 4 Isolated mitochondrial abnormality (IMA) was defined as presence of cytochrome c oxidase negative fibres and/or succinate dehydrogenase positive staining without inflammatory cell infiltrate or rimmed vacuoles.

    PM or NSM evolution towards IBM was evaluated at follow-up. Uncontrolled viral load was defined as >40 copies/mL.

    Categorical variables are reported herein as numbers and/or percentages and were compared using a χ2 or Fisher’s exact test. Quantitative variables are reported as median (IQR1–IQR3) and compared using non-parametric one-way one-way analysis of variance (ANOVA). For all statistical analyses, p<0.05 was considered significant. Statistical analyses were conducted using GraphPad Prism software.

    Results

    Fifty HIV-positive patients …

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    Footnotes

    • OL-C and LG contributed equally.

    • Contributors Conceptualisation and design: OL-C, LG, OB and YA. Acquisition of data: OL-C, LG, OD, TM, SL, DB, AS, AB, TS, CD, GB, AR, OF, M-CM, CL, M-AV, DV, J-FB, TH, M-PC, ZA, TdB, BE, NB, OB and YA. Analysis and interpretation: OL-C, LG, OB and YA. Critical revision of the manuscript for important intellectual content: OL-C, LG, OD, TM, SL, DB, AS, AB, TS, CD, GB, AR, OF, M-CM, CL, M-AV, DV, J-FB, TH, M-PC, ZA, TdB, BE, NB, OB and YA.

    • Competing interests OL-C is the recipient of Clinical Fellowship awards from the Université de Montréal Rheumatology Program - Abbvie Educational Grant and the Association des médecins rhumatologues du Québec - Visithan-Khy Educational Grant.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by local Ethics Committee (CPP Ile De France VI (2013-12-19), CCTIRS (N°14.323) and CNIL (915139)) for the use of medical information recorded in the myositis database for scientific purposes.

    • Provenance and peer review Not commissioned; externally peer reviewed.