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Diagnosing HIV-associated cerebral diseases - the importance of Neuropathology in understanding HIV
Ioan Alexandru Diaconu1, LaurenŢiu MihăiŢă Stratan, Luciana Nichita
1Infectious Diseases Clinic III, "Prof. Dr. Matei Bals" National Institute for Infectious Diseases, Bucharest, Romania; diaconuia@yahoo.com.
Insights
Clinical diagnoses for AIDS-associated neuroAIDS often mismatch post-mortem findings. Overdiagnosis rates increased significantly, while underdiagnosis also rose, indicating a need for improved diagnostic approaches in neuroAIDS.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Acquired Immune Deficiency Syndrome (AIDS) can cause central nervous system (CNS) pathology, known as neuroAIDS.
- Accurate ante mortem diagnosis of neuroAIDS is challenging, often relying on clinical assessments that may not align with post mortem findings.
Purpose of the Study:
- To compare clinical diagnoses of neuroAIDS with post mortem neuropathology results.
- To evaluate the accuracy of clinical diagnoses and identify discrepancies in AIDS-associated CNS pathology.
Main Methods:
- Retrospective analysis of 39 human immunodeficiency virus (HIV)-positive patients with AIDS-related complications.
- Comparison of ante mortem clinical diagnoses with post mortem brain necropsy findings.
- Statistical analysis of diagnostic concordance, overdiagnosis, and underdiagnosis rates over time.
Main Results:
- Significant discrepancies were observed between clinical and necroptic diagnoses for various neuroAIDS conditions, including progressive multifocal leukoencephalopathy (PML), cerebral cryptococcosis, and cerebral toxoplasmosis.
- The rate of overdiagnosis of AIDS-associated cerebral illness increased from 36% in 1993 to 124% in 2015 (p=0.037).
- Underdiagnosis rates also increased, and clinical confirmation rates remained stagnant between 1993 and 2015.
Conclusions:
- There is a notable gap between clinical and pathological diagnoses in neuroAIDS.
- The rising rates of overdiagnosis and underdiagnosis highlight the need for a more precise and multidisciplinary approach to diagnosing CNS pathology in AIDS patients.
- Improved diagnostic strategies are crucial for better patient management and outcomes in neuroAIDS.
Abstract:
The study aims to compare two aspects concerning the diagnosis of acquired immune deficiency syndrome (AIDS)-associated central nervous system (CNS) pathology (neuroAIDS): clinical diagnoses issued ante mortem with pathology results issued post mortem. The group of 39 human immunodeficiency virus (HIV)-positive patients was created over 23 years and is limited by marked heterogeneity. The enrolled cases were treated at the "Prof. Dr. Matei Bals" National Institute for Infectious Diseases, Bucharest, Romania, deceased due to AIDS-related complications and underwent brain necropsies performed in the Pathology Laboratory at the "Colentina" Clinical Hospital, Bucharest. The level of superposition between clinical and the necroptic diagnoses of neurological AIDS-associated diseases was: 60% for progressive multifocal leukoencephalopathy (PML), 50% for cerebral cryptococcosis, 33% for cerebral toxoplasmosis, 20% for cerebral lymphoma, null for cerebral tuberculosis, HIV encephalopathy (HIVE), neurosyphilis and cytomegalovirus cerebral infection. Half of the cases without an AIDS-associated CNS lesion were previously clinically overdiagnosed. We observed that the rate of overdiagnosis concerning an AIDS-associated cerebral illness has risen from 36% in 1993 to 124% in 2015, an elevation with statistical relevance [p=0.037, confidence interval (CI) 95%]. The rate of underdiagnosis has slowly risen from 24% in 1993 to 40% in 2015, however, with no statistical relevance. The rate of clinical confirmation has been stagnant in linear regression from 1993 to 2015. The results of our study reveal a gap between ante mortem and post mortem diagnoses, with many instances of overdiagnosis and underdiagnosis of several major AIDS-associated CNS illnesses, highlighting the need for a more detailed, multidisciplinary approach of neuroAIDS.
