Neuropathology of HIV infection: adults versus children

The lower incidence of complicating opportunistic and reactivated latent infections in the CNS of children with HIV infection has resulted in a "cleaner" system, allowing better appreciation of the lesions associated with primary HIV brain infection. The most striking differences that we have seen in the CNS of children, when compared to adults with regard to primary HIV infection, have been the following: More florid inflammation and more frequent MGC in the children; more frequent localization of MGC in the cerebral cortex in children; more basophilic mineralization in the children; more perivascular brown pigment in the adults; and more obvious white matter changes in the adults. It has been noted that the median survival time for children under one year of age with AIDS is significantly less than that for older children (6.5 months vs. 19.7 months). Thus the tempo of HIV infection would seem to be more rapid in children, particularly young children. Our own neuropathological observations would support the hypothesis of a more fulminant CNS disease in children, in keeping with the well-known phenomenon of increased virulence of viral infections in the immature central nervous system.