Neuropathology of AIDS

Involvement of the central and peripheral nervous systems as a result of primary infection by the human immunodeficiency virus (HIV) or due to secondary opportunistic infections and neoplasms has been recognized as a major clinical problem in patients with the Acquired Immunodeficiency Syndrome (AIDS). Currently, of new AIDS cases, 30 to 40% will have clinical evidence of nervous system dysfunction. Neurologic dysfunction will be the presenting problem in 10% of patients. Greater than 75 to 90% of AIDS victims will exhibit nervous system pathology at autopsy. The neuropathologic findings in AIDS can best be examined by separating them into three distinct groups: opportunistic infections, neoplasms, and proposed direct effects of HIV infection. This review considers each of these categories and relates them in turn to the current understanding of the biology of the virus, its epidemiology, and its interaction with the host.