HIV myelopathy, peripheral neuropathy, and myopathy

Examination reveals paraparesis, lower extremity spasticity or both. Increased thresholds of vibration and proprioception with positive Romberg’s sign result from posterior column impairment. Pain and temperature are usually preserved, unless there is superimposed peripheral neuropathy. Deep tendon reflexes, particularly the patellar, are hyperactive, with bilateral ankle clonus and extensor plantar responses. Gait ataxia with impaired tandem may also be seen. In advanced cases, patients may be unable to ambulate and may eventually be wheelchair-bound.