HIV neuromuscular disease and mitochondrial function

The pathogenesis of neuromuscular syndromes in HIV-infected patients is multifactorial. Of recent concern is the mitochondrial-mediated neuromuscular pathology in HIV and its treatment. We present currently available evidence supporting the role of mitochondrial pathology in the peripheral nerve and muscle disorders due to HIV infection and antiretroviral (ARV) therapy. Three neuromuscular syndromes are discussed: distal symmetric polyneuropathy (DSP), myopathy, and HIV-associated neuromuscular weakness syndrome (HANWS). Myopathy has the most in-vivo data relating to HIV-related mitochondrial pathology, while DSP and HANWS have growing evidence of mitochondrial pathology, particularly in the context of ARV use. It is likely that these neuromuscular disorders result from a combination of mitochondrial and immunological mechanisms due to HIV and ARV therapy.