Guillain-Barré ³yndrome is a paralytic condition caused by damage to the myelin coat that sheaths the nerves. It is a relatively rare condition but can occur early in HIV infection, soon after infection or when little immune damage has occurred. It is caused by an auto-immune mechanism in which macrophages destroy the myelin sheath, preventing the nerve from sending electrical signals properly.

A similar syndrome has also been associated with nucleoside analogue treatment, particularly with d4T (stavudine, Zerit), in a small number of cases. See Lactic acidosis / acidaemia in Symptoms and illnesses: A to Z of illnesses for further details.

It is also known as acute inflammatory demyelinating neuropathy or AIDP.

Symptoms and diagnosis

The typical symptoms of Guillain-Barré ³yndrome begin with tingling in the hands and feet, followed by a gradually increasing weakness that can spread to the arms, legs and face and affect functions such as swallowing, eye movement and breathing. Normally the effects are symmetrical, rather than affecting one arm but not the other, for example. The bowel and bladder are not affected. This progression can be rapid within hours or take weeks.

The condition is confirmed by electrodiagnostic studies (EDS) to test nerve function, tests on the cerebrospinal fluid (CSF) and by eliminating other possible causes of paralysis.

Treatment

Guillain-Barré ³yndrome is a very serious condition that needs urgent medical attention. The main treatment is plasma exchange, in which a quantity of blood is taken from the body and the antibodies and lymphocytes, which may be causing the auto-immune attack on the nerves, are removed. The red blood cells are then returned to the body. Alternatively, intravenous immunoglobulin may be prescribed. Steroids are not an effective treatment.

A case study has been reported in which an HIV-infected person with CMV-related Guillain-Barré ³yndrome recovered from this neurological condition after treatment with highly active antiretroviral therapy (HAART) and ganciclovir (Calza 2001).

On average, 50% of people with Guillain-Barré ³yndrome have begun to improve one week after the attack begins, and 90% after one month. It is fatal in around 5% of cases.

Reference

Calza L et al. Role of gancyclovir and HAART administration in the treatment of a rare complication of HIV disease: cytomegalovirus-associated Guillain-Barré ³yndrome. Journal of Chemotherapy 13(5): 575-577, 2001.