Ten-year plateau phase in human immunodeficiency virus induced motor neuron disease upon antiretroviral therapy: a first case from Eastern Africa.


  • Marjolein de Bruin haaglanden medisch centrum
  • Emmanuel Assay
  • Asha Osman
  • Kajiru Kilonzo
  • William Howlett
  • Marieke Dekker




Amyotrophic lateral sclerosis, HIV, HIV-ALS, motor neuron disease, Eastern Africa


We report an individual with rapidly progressive motor neuron disease (MND), phenotypically compatible with amyotrophic lateral sclerosis (ALS). The patient described in this case report proved positive for human immunodeficiency virus (HIV) and was initiated on antiretroviral therapy (ART). Following ART he clinically stabilised over 10 years and deteriorated again due to noncompliance or ART resistance. HIV infection can give rise to an MND mimic, HIV-ALS. The improvement in response to ART supports the notion that HIV-ALS is a treatable entity also in Africa. This is the first case report of a patient with HIV-ALS and long term follow up in Sub-Saharan Africa. The report raises the suggestion that an additional (retro)virus can play a role in the aetiology of ALS.


Download data is not yet available.


1. Disease GBD, Injury I, Prevalence C. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1545-602.
2. Dekker MCJ, Urasa SJ, Howlett WP. Neurological letter from Kilimanjaro. Pract Neurol 2017; 17(5): 412-6.
3. Quansah E, Karikari TK. Motor Neuron Diseases in Sub-Saharan Africa: The Need for More Population-Based Studies. Biomed Res Int 2015; 2015: 298409.
4. Dekker MCJ, Urasa SJ, Aerts MB, Howlett WP. Motor neuron disease in sub-Saharan Africa: case series from a Tanzanian referral hospital. J Neurol Neurosurg Psychiatry 2018; 89(12): 1349-50.
5. Spillane JD. Tropical neurology. Proc R Soc Med 1969; 62(4): 403-10.
6. Osuntokun BO. The pattern of neurological illness in tropical Africa. Experience at Ibadan, Nigeria. J Neurol Sci 1971; 12(4): 417-42.
7. Moodley K, Bill PLA, Bhigjee AI, Patel VB. A comparative study of motor neuron disease in HIV-infected and HIV-uninfected patients. J Neurol Sci 2019; 397: 96-102.
8. Howlett WP. Neurological disorders in HIV in Africa: a review. Afr Health Sci 2019; 19(2): 1953-77.
9. Ghosn J, Taiwo B, Seedat S, Autran B, Katlama C. Hiv. Lancet 2018; 392(10148): 685-97.
10. Bowen LN, Tyagi R, Li W, Alfahad T, Smith B, Wright M, et al. HIV-associated motor neuron disease: HERV-K activation and response to antiretroviral therapy. Neurology 2016; 87(17): 1756-62.
11. Alfahad T, Nath A. Retroviruses and amyotrophic lateral sclerosis. Antiviral Res 2013; 99(2): 180-7.
12. Moulignier A, Moulonguet A, Pialoux G, Rozenbaum W. Reversible ALS-like disorder in HIV infection. Neurology 2001; 57(6): 995-1001.
13. MacGowan DJ, Scelsa SN, Waldron M. An ALS-like syndrome with new HIV infection and complete response to antiretroviral therapy. Neurology 2001; 57(6): 1094-7.
14. Verma A, Berger JR. ALS syndrome in patients with HIV-1 infection. J Neurol Sci 2006; 240(1-2): 59-64.
15. Lorenzoni PJ, Ducci RD, Dalledone GO, Kay CSK, de Almeida SM, Werneck LC, et al. Motor neuron disease in patients with HIV infection: Report of two cases and brief review of the literature. Clin Neurol Neurosurg 2018; 171: 139-42.
16. Hoffman PM, Festoff BW, Giron LT, Jr., Hollenbeck LC, Garruto RM, Ruscetti FW. Isolation of LAV/HTLV-III from a patient with amyotrophic lateral sclerosis. N Engl J Med 1985; 313(5): 324-5.
17. HIV and AIDS in Tanzania. www.unaids.org2019).
18. Orsini M, Oliveira AB, Nascimento OJ, Reis CH, Leite MA, de Souza JA, et al. Amyotrophic Lateral Sclerosis: New Perpectives and Update. Neurol Int 2015; 7(2): 5885.
19. Mochan A. HIV related motor neuron disease/syndrome: The - potentially treatable - retroviral link in ALS? J Neurol Sci 2019; 397: 75-6.
20. Douville R, Liu J, Rothstein J, Nath A. Identification of active loci of a human endogenous retrovirus in neurons of patients with amyotrophic lateral sclerosis. Ann Neurol 2011; 69(1): 141-51.
21. Jubelt B, Berger JR. Does viral disease underlie ALS? Lessons from the AIDS pandemic. Neurology 2001; 57(6): 945-6.
22. Li W, Lee MH, Henderson L, Tyagi R, Bachani M, Steiner J, et al. Human endogenous retrovirus-K contributes to motor neuron disease. Sci Transl Med 2015; 7(307): 307ra153.




How to Cite

de Bruin, M., Assay, E. ., Osman, A., Kilonzo, K., Howlett, W., & Dekker, M. (2020). Ten-year plateau phase in human immunodeficiency virus induced motor neuron disease upon antiretroviral therapy: a first case from Eastern Africa. RRNMF Neuromuscular Journal, 1(5), 29–32. https://doi.org/10.17161/rrnmf.v1i5.13809



Clinic Stuff (Case Reports)