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CATIE News – Restless legs and HIV
Complications affecting the nervous system are common in people with HIV/AIDS (PHAs). In part these arise because HIV-infected cells produce proteins that affect the health of cells in the brain and spinal cord as well as nerve cells in the rest of the body. As a result, some brain cells can malfunction and even die, as can nerves in the rest of the body. Some of the complications that can affect the nervous systems of PHAs include the following:
* difficulty concentrating
* poor memory
* difficulty thinking clearly
* problems controlling muscles
* difficulty coordinating movement
* pain or numbness in nerves in the hands, legs and feet
Now doctors at the University of Münster in Germany have found what may be an additional complication—restless legs syndrome (RLS).
RLS is the term for a group of symptoms whereby people feel compelled to move their legs, feet or, in some cases, arms. The need to move legs occurs when a person is lying down or sitting for prolonged periods. Relief from RLS usually occurs when affected people do the following:
* stretch
* shake or wriggle their legs
* walk
* engage in exercise
Symptoms of RLS are usually more troublesome at night. People affected by this syndrome often have sleep disturbances—waking up prematurely or difficulty falling or staying asleep.
The precise cause of RLS is unclear. Some researchers suggest that there may be an insufficient level of a nerve-signaling compound called dopamine in the nerves of affected people.
In general, RLS is not linked to a serious underlying medical condition. But sometimes RLS can be found in people with the following symptoms or disorders:
* damaged nerves in the hands and feet (peripheral neuropathy); this can arise from alcohol abuse, diabetes or HIV infection
* insufficient iron
* severe kidney damage; when kidneys malfunction the level of iron in the blood can decrease
Some researchers think that there may be some kind of link between abnormal immunity and RLS. For instance, conditions in which the immune system attacks itself or parts of the body (autoimmunity) have been noted to carry an increased risk for RLS. These autoimmune conditions can include the following:
* rheumatoid arthritis
* multiple sclerosis
* diabetes
Researchers at the University of Münster have theorized that since HIV damages the immune system and increases the risk of peripheral neuropathy perhaps it also carries an increased risk for RLS. They conducted a pilot study to find out. The results from this study suggest that RLS may be more common in PHAs than in HIV negative people.
Study details
Researchers handed out or mailed surveys to 228 PHAs; only 129 PHAs responded. The study team then compared health information from 100 similar HIV negative people to the 129 PHAs. The average profile of PHAs in this study was as follows:
* 14% female, 86% male
* age – 44 years
* CD4+ count – 333 cells
* 44% of participants had AIDS-related symptoms in the past
* 82% of participants were taking HAART
Results
Of the 129 PHAs who responded to the survey, 33% had RLS compared to 7% of the HIV negative people. Moreover, PHAs were more likely to have severe symptoms of RLS. Also, the lower a PHA’s CD4+ count, the more likely the severity of RLS.
About 20% of PHAs with RLS also had a relative with RLS. None of the HIV negative people reported having relatives with RLS.
PHAs with RLS were more likely to have other complications, including the following:
* difficulty falling asleep
* difficulty staying asleep
* unexpected daytime tiredness
Bear in mind
The researchers suspect that RLS may have an underlying immunological link, though they cannot identify it at this time. That about 33% of PHAs had this problem is noteworthy because that is about the proportion of people with RLS in some other studies of immunological disorders such as rheumatoid arthritis and multiple sclerosis. The study team highlights the apparent relationship between RLS and reduced CD4+ count in PHAs.
A major weakness of this study was its recruitment of volunteers from hospital-based clinics specializing in neurology and internal medicine. These sources of recruitment may have led to an excessive intake of PHAs with nervous system disorders. Still, the German study is an important first step in identifying RLS in PHAs. Hopefully, this research will stimulate other research centres to also study RLS in this population.
Although the intent of the study was not to assess the effectiveness of therapy for RLS, doctors at the University of Münster’s clinics prescribed L-dopa (dopamine) for 10 of their PHA patients. According to the research team, responses to therapy were “good to excellent.”
—Sean R. Hosein
REFERENCES:
1. Happe S, Kundmüller, Reichelt D, et al. Comorbidity of restless legs syndrome and HIV infection. Journal of Neurology 2007 Oct;254(10):1401-6.
2. Stefansson H, Rye DB, Hicks A, et To see a directory of archived messages, visit CATIE's Web site at http://www.catie.ca/catienews.nsf
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