Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. I'm 56 yr old male 6'1" 185 lbs, POZ since 1992, on d4T, 3TC, crixivan combo for 6.5 years. Also take acyclovir for herpes (one capsule daily for past 9 yrs) and for the past year, metformin and glyburide for Type II diabetes (well controlled). Viral load hovers around 1,000 for past 2 yrs and T-cells around 250 (originally diagnosed in 1992 with 300 T-cells). Never had any opportunistic infections. Some neuropathy in feet and toes for over 8 years, beginning when on DDI monotherapy and continued even after stopping DDI after 2 yrs.
For past two years have had weakness in calf muscles, even though I can currently leg press 320 lbs in gym and go 30 min. on elliptical trainer. At 13.75 inches, the calf muscles are not atrophied. I feel calf weakness when walking and can not walk fast or far without losing strength. About 2 years ago used to have bad calf muscle spasms at night and especially in the morning; leg stretches and calcium/magnesium did not help. Also, had pitting edema in ankles. Cramps and swelling disappeared and it seemed that calf weakness improved a little when given strong support stockings for varicose veins. This past summer stopped wearing stockings due to heat, but cramps and swelling have not returned. The only other change is adding 500 mg of L-carnitine and 500 of acetyl L-carnitine about 6 months ago to the many other supplements I take. Calf weakness seemed to have improved a little but it is still a problem. I am thinking about increasing the carnitine.
I don't expect much from a scheduled neurology exam next month, since I am thinking that mitochondrial toxicity is more likely. No one seems to know anything and I can find nothing in the literature about weakness limited just to the calf muscles. Any suggestions?
Marty Markowitz, M. D.
Clinical Director
Staff Investigator, Aaron Diamond AIDS Research Center
Associate Professor, Rockefeller University
A few suggestions:
A detailed neurologic exam with nerve conduction studies, and
perhaps even a muscle biopsy may be helpful....
I suspect this is nucleoside related, likely D4T....I would try an empiric switch to TDF tenofovir, Viread) if nothing is apparent to the neurologist...
Furthermore, I would not be content with a viral load of 1,000 while on therapy; you might talk to your provider about this.
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