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Muscle Aches and Pains

Muscle aches and pains are common, especially as we age, but they can be a sign that medical attention is needed. Tell your healthcare provider about any ongoing muscle pains, as they can be very serious. 

Figuring out the cause

Everyone has the occasional muscle ache, especially as they age. But people living with HIV can experience more serious muscle conditions, including muscle pain, muscle cramping and muscle disorders that result in weakness. The pain often involves the back, hips or lower limbs.

To distinguish between minor and more severe muscle problems, it is very important to visit your healthcare provider when any muscle problems develop. This is not a time for self-diagnosis. Your muscle problem could be something relatively minor, but it could also be a serious problem that only a healthcare provider can properly diagnose.

Tell your healthcare provider about any muscle weakness, aches or pains you develop so that a proper workup can determine the cause. In particular, it is very important to rule out any neurologic diseases (HIV-related or not) that could be causing your symptoms.

Myopathy

Myopathy is a muscle disorder that results in weakness, often leading to musculoskeletal pain involving the back, hips or lower limbs. Myopathy can sometimes be caused by:

  • lipid-lowering drugs (statins)
  • vitamin D deficiency
  • essential amino acid deficiencies
  • testosterone deficiency
  • neurological problems
  • AZT (Retrovir and in Combivir, Trizivir and in generic formulations). If this drug is used at all today, it is for brief periods in certain situations. 

In extremely rare cases, the use of integrase inhibitors, including raltegravir (Isentress), elvitegravir (in Stribild) dolutegravir (Tivivay, and in Dovato, Juluca, Triumeq) and bictegravir (in Biktarvy), may lead to persistent fatigue and muscle weakness. However, this is very rare. 

Changing or stopping a problematic drug can solve muscle problems related to that drug. However, this may not be an option when the medication causing the problem is needed as part of your antiretroviral combination.

Although Aspirin and other over-the-counter pain medicines such as acetaminophen (Tylenol) can help counter muscle aches and pains, they don’t really solve the underlying cause of muscle problems

Lactic acidosis

It is also important to rule out lactic acidosis. This problem was once relatively common in the past when drugs such as d4T and ddI were used. Today, other nucleoside analogues are used and lactic acid is extremely rare. 

Amino acid supplements

Amino acid deficiencies can sometimes be the underlying cause of muscle weakness. Muscle is mostly composed of protein and protein is made up of amino acids. Thus, essential amino acid deficiencies can cause muscle weakness. Deficiencies sometimes result from poor protein digestion. Gas or bloating after meals can be a sign of poor protein digestion, so if this is an ongoing problem for you, and you are experiencing muscle weakness, talk to your healthcare provider about the possibility of amino acid deficiency. In some cases, a supplement that includes all of the essential amino acids can help reverse muscle weakness.

Look for a supplement that contains all eight essential amino acids: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. The total daily requirement for essential amino acids is a minimum of 50 to 60 grams daily, though this varies based on your weight and activity levels. You will get a lot of this from the food you eat if you have good digestion. However, to bring your amino acid levels back up and help reverse muscle weakness, you may need to take five to 10 grams daily of an essential amino acid supplement. Talk to a health professional about what dose is right for you. It can take several weeks to notice a change, but if you don’t see any improvement in muscle strength within three to four months, then amino acid deficiency may not be causing your muscle weakness.

Glutamine is a specific amino acid often deficient in people living with HIV. Glutamine is involved in many aspects of healthy body function, including maintaining antioxidant levels, building and maintaining muscle tissue, strengthening immune function and repairing and maintaining intestinal tissue. Although glutamine is classified as “non-essential,” meaning the body can normally synthesize what it needs, it may be deficient in some people living with HIV. The deficiency can result in both muscle weakness and actual wasting away of muscle tissue.

At least five to 10 grams of glutamine daily is recommended to maintain optimal levels People living with HIV who have muscle wasting will have depleted glutamine, since it is found mostly in the muscles. In these cases, higher doses are recommended. Glutamine is available in powdered form and is best mixed into water or juice and taken on an empty stomach (at least a half hour before eating), with the total daily dose divided into at least three doses.

Research has shown that doses of the amino acid L-carnitine can help with myopathy. In these studies, 3,000 mg daily of L-carnitine usually reversed the myopathy and helped people feel substantially better. L-carnitine may help to reverse the mitochondrial toxicity caused by older nucleoside analogues. 

A more effective form of L-carnitine is acetyl-L- carnitine. The usual dosage is 500 mg taken three times daily with meals. Doses of acetyl-L-carnitine can be lower than doses of plain L-carnitine because the acetyl-L-carnitine releases four times as much free carnitine into the bloodstream using equivalent doses. But be careful about taking too much carnitine, as it can cause diarrhea.

Vitamins 

Vitamin D supplements may be helpful in some people with muscle weakness and associated pains. Multiple studies in HIV-negative people have shown that deficiency of vitamin D can cause serious muscle weakness and associated musculoskeletal pain involving the back, hips or lower limbs. Vitamin D deficiency is a common problem in people living with HIV, so it is very important to consider vitamin D deficiency in anyone who has developed muscle weakness and pain.

The link between vitamin D deficiency and muscle problems and pain is not known by all healthcare professionals. For this reason, talk with your healthcare provider about having your vitamin D level tested, and then consider taking vitamin D3 supplements. The cost of the test may not be covered by all provincial or territorial healthcare plans, or it may be covered only in certain situations. Check with your healthcare provider for availability in your region. 

Magnesium supplements can sometimes help relieve muscle problems, especially muscle cramping. If you have recurrent muscle cramps, or the Charley horse type of cramping in your calf muscles that can occur during sleep, it might be caused by magnesium deficiency. Constipation is another symptom that may be due to magnesium deficiency. Painful menstrual cramping is another indicator. Any combination of such symptoms may indicate that you need magnesium supplementation.

Because individual needs can differ widely, you will have to experiment to see what dose of magnesium solves your problems. Naturopathic healthcare providers often suggest starting with a dose of 250 to 350 mg daily taken with food. People who are at risk of having too low levels of magnesium and who are also taking calcium supplements often take the two supplements at different times of the day, since calcium can block the absorption of magnesium.

If the initial dose is insufficient to resolve muscle cramping, then try gradually increasing the amount you take. If you take too much magnesium, you may get explosive diarrhea. Magnesium glycinate may be better tolerated than other forms of magnesium. Epsom salts contain magnesium and, when dissolved in a hot bath, may also help ease muscle pain and cramping.