[Neuropathology of AIDS: Montefiore experience]

From September 1982 to December 1988 113 cases of AIDS have been autopsied and the brains examined at Montefiore Medical Center. Findings in four areas were presented; 1. Opportunistic infections In approximately one third of cases there were opportunistic infections which were often the cause of death. Cryptococcus, cytomegalovirus and toxoplasma were the three most common infections followed by papovavirus (progressive multifocal leukoencephalopathy) and herpes zoster. Tuberculosis, aspergillosis, histoplasmosis and infection with mycobacterium avium-intracellulare infection were found in only one case each. 2. Malignant lymphoma Both primary and metastatic lymphomas were seen in almost 10% of the cases. 3. HIV encephalitis This conclusion is regarded as the pathological substrate of "AIDS dementia complex" described by the neurologists. In general, it was characterized by cerebral atrophy and diffuse pallor of the white matter with gliosis. The basal ganglia and other areas of the CNS were also often involved. Histologically, there was perivascular infiltration of lymphocytes, macrophages and multinucleated giant cells. Microglial nodules were commonly seen. Electron microscopic and other techniques demonstrates the HIV virus within macrophages and multinucleated cells. 4. Cerebrovascular lesions These lesions are known in AIDS but their high frequency is not generally appreciated unless a careful search for microinfarcts is made. Microinfarcts were found in approximately 1/3 of our cases.