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Lou Gehrig's Disease Linked to Virus

24 September 2001 7:00 pm
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Culprit? HIV causes a Lou Gehrig's-like disease in some patients.

The AIDS virus can cause a version of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, that can be treated effectively with antiretroviral drugs, according to two studies reported in the 25 September issue of Neurology. The results bolster the case for a viral cause of ALS and show that at least some rare cases of motor neuron disease can be reversed.

As ALS patients get sicker, their motor neurons degenerate, causing muscles throughout the body to atrophy. Despite decades of research, it's still not clear what kills the neurons. Researchers have long suspected a virus, perhaps one related to poliovirus or HIV, but evidence was circumstantial. To see whether HIV was associated with motor neuron disease, neurologist Antoine Moulignier of Rothschild Hospital in Paris, France, and his colleagues examined records from 1700 patients with either HIV or neurological symptoms who had been treated at the hospital between 1987 and 2000.

The researchers identified six HIV-infected patients who had developed ALS symptoms, an incidence 27-fold higher than the general population. The syndrome developed much faster than ordinary ALS, within weeks or months, rather than 2 to 5 years; it also struck at a younger age. The researchers tested tissue samples to rule out other causes of neural degeneration, such as herpes, cytomegalovirus, and syphilis. Although ordinary ALS is irreversible, two of the patients with the new syndrome recovered after antiretroviral drugs beat the virus into submission.

In a separate paper, neurologist Daniel MacGowan of Beth Israel Medical Center in New York City and his colleagues report a similar case: a 32-year-old woman who quickly developed ALS symptoms and was soon found to be HIV positive. At first, the woman was bed-ridden, eating through a tube, and unable to talk. She recovered completely after a yearlong treatment with three antiretroviral drugs that rendered virus levels undetectable.

The New York case was "sort of revolutionary because most ALS syndromes don't get better," says neurologist Lewis Rowland of Columbia University in New York City. The reports mean that researchers should test patients to see if HIV infection raises the risk of ALS-like symptoms, and "it again raises the question whether ALS itself is caused by some other persistent viral infection," he concludes.

Related sites

Background on ALS, from the National Institute of Neurological Disorders and Stroke
Background on HIV/AIDS from the Centers for Disease Control and Prevention

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