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Human immunodeficiency virus (HIV) leukoencephalopathy and the microcirculation
T W Smith1, U DeGirolami, D Hénin
1Department of Pathology (Neuropathology), University of Massachusetts Medical Center, Worcester 01655.
Journal of Neuropathology and Experimental Neurology
|July 1, 1990
Summary
Acquired immune deficiency syndrome (AIDS) dementia involves brain white matter damage. Human immunodeficiency virus type 1 (HIV-1) infection of brain blood vessels may cause this neurological damage.
Area of Science:
- Neuropathology
- Neurovirology
- Neuroimmunology
Background:
- Investigating the neuropathogenesis of dementia in patients with acquired immune deficiency syndrome (AIDS) not associated with opportunistic infections or neoplasms.
- Examining the role of human immunodeficiency virus type 1 (HIV-1) in the central nervous system (CNS) pathology.
Observation:
- Three AIDS patients presented with subacute progressive dementia.
- CT scans revealed cortical atrophy, ventricular dilation, and white matter hypodensity.
- Microscopic analysis showed myelin pallor, gliosis, axonal damage, and striking microvascular changes.
Findings:
- HIV-1 antigens were detected in perivascular macrophages and multinucleated giant cells (MNGC).
- Microvascular abnormalities included endothelial cell enlargement, increased cellularity, and mural thickening.
- These vascular changes and HIV-1 infected cells suggest a role in mediating white matter injury.
Implications:
- Morphological changes in cerebral microvasculature may disrupt the blood-brain barrier.
- Increased vascular permeability could lead to white matter damage (myelin and axonal loss) and cerebral atrophy.
- HIV-1 infected perivascular cells may be key mediators of vascular injury in AIDS dementia complex.