What is the pathophysiology of HIV-associated vacuolar myelopathy (VM)?

Updated: May 07, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Several hypotheses have been proposed to explain the development of vacuolar myelopathy (VM). One hypothesis is infiltration by HIV-infected mononuclear cells that secrete neurotoxic factors, including cytokines, possibly in conjunction with neurotoxic astrocyte factors. Transgenic mice that express HIV gene products in oligodendrocytes develop clinical and histologic features that resemble the human disease. [1] Although direct HIV infection of astrocytes and neurons is reported in the brain and dorsal root ganglia, it is not a major feature in VM. Impaired utilization of vitamin B-12 as a source of methionine in transmethylation metabolism for myelin maintenance in the spinal cord may be a contributing factor. [2]

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