The neuropathology of human immunodeficiency virus infection. The Dallas, Texas, experience

Postmortem neuropathologic changes were evaluated in 141 consecutive patients dying with human immunodeficiency virus infection at publicly supported hospitals affiliated with the University of Texas Southwestern Medical Center in Dallas, between August 1984 and September 1990. Morphologic abnormalities were identified in 112 cases (79%). Cytomegalovirus was the most common opportunistic infection encountered, with characteristic viral inclusions identified in 23 patients, and presumptive evidence of infection in six additional patients. Progressive multifocal leukoencephalopathy was present in four patients. Gram-positive bacterial infections were identified in six patients, and mycobacterial infections in three patients. Opportunistic fungal infections included cryptococcosis (13 cases), histoplasmosis (two cases), and coccidioidomycosis (one case). Toxoplasmosis was uncommon, with active or quiescent lesions identified in five patients. Lymphoma was present in nine patients and was primary in the central nervous system in five patients. Multinucleate giant cell (human immunodeficiency virus) encephalitis was identified in 28 patients. In an additional 26 patients, microglial nodules and/or more generalized white-matter abnormalities were encountered in the absence of multinucleate giant cells, cytomegalovirus inclusions, or systemic cytomegalovirus infection. Vacuolar change was present in 21% of spinal cords, and was highly correlated with cytomegalovirus infection in the nervous system. Mixed infections and/or neoplasms were identified in 24 patients. This survey documents a high frequency of neuropathologic abnormalities in human immunodeficiency virus-infected individuals in a geographical region of the United States not represented in previous series. Variations noted in the frequencies of specific central nervous system disorders between this and other study populations reinforce the need for continuing documentation of geographical trends in human immunodeficiency virus-associated disorders.