How is HIV-associated vacuolar myelopathy (VM) treated?

Answer

Care for patients with HIV-associated vacuolar myelopathy (VM) is primarily supportive. Although no specific treatment is currently approved for this syndrome, viral control tailored to the individual patient's medical and viral history is important, as clinical and radiologic improvement with highly active retroviral therapy (HAART) have been described.^{[12, 13, 14, 5]}

A pilot study showed improvement in patients treated with L-methionine.^[15]However, a randomized, double-blind, placebo-controlled study of 56 patients showed no benefit.^[16]

Symptomatic management relies on antispasmodics such as baclofen or tizanidine and intramuscular botulinum toxin to manage spasticity, pain management, and anticholinergic drugs to improve bladder function.^[17]

Refer the patient to a physical medicine specialist for spinal cord treatment and follow-up care.

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Goudreau G, Carpenter S, Beaulieu N, Jolicoeur P. Vacuolar myelopathy in transgenic mice expressing human immunodeficiency virus type 1 proteins under the regulation of the myelin basic protein gene promoter. Nat Med. 1996 Jun. 2 (6):655-61. [Medline].
Di Rocco A, Bottiglieri T, Werner P, et al. Abnormal cobalamin-dependent transmethylation in AIDS-associated myelopathy. Neurology. 2002. 58:730-735. [Medline]. [Full Text].
Anneken K, Fischera M, Evers S. Recurrent vacuolar myelopathy in HIV infection. J Infect. 2006 Jun. 52(6):e181-3. [Medline].
Dal Pan GJ, Glass JD, McArthur JC. Clinicopathologic correlations of HIV-1-associated vacuolar myelopathy: an autopsy-based case-control study. Neurology. 1994 Nov. 44 (11):2159-64. [Medline].
Tagliati M, Di Rocco A, Danisi F, Simpson DM. The role of somatosensory evoked potentials in the diagnosis of AIDS-associated myelopathy. Neurology. 2000 Apr 11. 54(7):1477-82. [Medline].
Chong J, Di Rocco A, Tagliati M, et al. MR findings in AIDS-associated myelopathy. AJNR Am J Neuroradiol. 1999 Sep. 20(8):1412-6. [Medline].
Santosh CG, Bell JE, Best JJ. Spinal tract pathology in AIDS: postmortem MRI correlation with neuropathology. Neuroradiology. 1995 Feb. 37(2):134-8. [Medline].
Sartoretti-Schefer S, Blattler T, Wichmann W. Spinal MRI in vacuolar myelopathy, and correlation with histopathological findings. Neuroradiology. 1997 Dec. 39(12):865-9. [Medline].
Eilbott DJ, Peress N, Burger H, et al. Human immunodeficiency virus type 1 in spinal cords of acquired immunodeficiency syndrome patients with myelopathy: expression and replication in macrophages. Proc Natl Acad Sci U S A. 1989 May. 86(9):3337-41. [Medline].
Tyor WR, Glass JD, Baumrind N, et al. Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy. Neurology. 1993 May. 43(5):1002-9. [Medline].
Petito CK, Navia BA, Cho ES, et al. Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1985 Apr 4. 312(14):874-9. [Medline].
Bizaare M, Dawood H, Moodley A. Vacuolar myelopathy: a case report of functional, clinical, and radiological improvement after highly active antiretroviral therapy. Int J Infect Dis. 2008 Jul. 12(4):442-4. [Medline].
DiRocco A. HIV-associated myelopathy. Current Treatment Options in Infectious Diseases. Vol 5. 2003:457-465.
Fernandez-Fernandez FJ, de la Fuente-Aguado J, Ocampo-Hermida A. Remission of HIV-associated myelopathy after highly active antiretroviraltherapy. J Postgrad Med. 2004. 50(3):195-6. [Medline].
Di Rocco A, Tagliati M, Danisi F, et al. A pilot study of L-methionine for the treatment of AIDS-associated myelopathy. Neurology. 1998 Jul. 51(1):266-8. [Medline].
Di Rocco A, Werner P, Bottiglieri T, et al. Treatment of AIDS-associated myelopathy with L-methionine: a placebo-controlled study. Neurology. 2004 Oct 12. 63(7):1270-5. [Medline].
Elyse J. Singer, Miguel Valdes-Sueiras, Deborah Commins, Andrew Levine. Neurologic Presentations of AIDS. Neurology Clinics. Feb 2010. 28 (1):253-75. [Medline]. [Full Text].
Staudinger R, Henry K. Remission of HIV myelopathy after highly active antiretroviral therapy. Neurology. 2000 Jan 11. 54(1):267-8. [Medline].

Media Gallery

Spinal cord from patient with vacuolar myelopathy that shows extensive spongiform changes in the white matter (Luxol fast blue stain) (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
Marked vacuolation is apparent in this Luxol fast blue stained photomicrograph (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
High-intensity lesion in the C2-C5 posterior spinal cord on T2-weighted sagittal MRI consistent with HIV myelopathy.
High-intensity lesion in the posterior cervical cord on T2-weighted axial MRI consistent with HIV myelopathy.

of 4

Author

Krupa Pandey, MD Assistant Professor of Neurology, Department of Neurology, Hackensack Meridian School of Medicine at Seton Hall University; Neurologist in Multiple Sclerosis, Neuroscience Institute at Hackensack University Medical Center; Adjunct Professor of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone School of Medicine

Krupa Pandey, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Biogen; Sanofi-Genzyme; Teva; Serono; Genentech<br/>Serve(d) as a speaker or a member of a speakers bureau for: Biogen; Sanofi-Genzyme; Teva; Genentech.

Coauthor(s)

Florian P Thomas, MD, PhD, MA, MS Chair, Neuroscience Institute and Department of Neurology, Director, National MS Society Multiple Sclerosis Center and Hereditary Neuropathy Foundation Center of Excellence, Hackensack University Medical Center; Founding Chair and Professor, Department of Neurology, Hackensack Meridian School of Medicine at Seton Hall University; Professor Emeritus, Department of Neurology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

Prityi Rani, MD General Neurologist, Headache, Stroke, and Neuromuscular, Jefferson City Medical Group

Prityi Rani, MD is a member of the following medical societies: American Academy of Neurology, Indian Medical Association, International Headache Society

Disclosure: Nothing to disclose.

How is HIV-associated vacuolar myelopathy (VM) treated?

Answer

Related Questions:

About

Membership

Apps

WebMD Network

Editions

How is HIV-associated vacuolar myelopathy (VM) treated?

Answer

Related Questions:

References

Tables

Contributor Information and Disclosures

Find Us On

About

Membership

Apps

WebMD Network

Editions