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changes are not common. Possible causes of HIV-wasting syndrome include increased release of
the proinflammatory cytokines interleukin (IL)-1 and tumor necrosis factor (TNF)-alpha from
HIV-infected monocytes/macrophages. Additionally, the ubiquitin-ATP-dependent proteolytic
system is activated in muscle from cachectic AIDS patients, possibly in response to changes in
circulating cytokines. There is also increased expression of the negative regulator of skeletal
muscle growth myostatin.[814]
Myasthenia gravis (MG) is an uncommon complication in HIV-infected patients, most
often occurring in early stages of disease, and can be the presenting manifestation. It tends to be
a transient phenomenon that diminishes with increasing immunosuppression. MG is assessed by
the edrophonium test and electromyography. HIV-associated MG is not always accompanied by
the presence antibodies to acetylcholine receptors, but muscle specific kinase antibodies may be
present.[813,814]
