Pathologic features of AIDS encephalopathy in children: evidence for LAV/HTLV-III infection of brain
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Neuropathologic examination of children with acquired immunodeficiency syndrome (AIDS) revealed a distinct CNS disorder. Findings included brain weight reduction, inflammation, and white matter changes, linked to the LAV/HTLV-III virus.
Area of Science:
- Neuropathology
- Virology
- Pediatric Neurology
Background:
- Acquired immunodeficiency syndrome (AIDS) can manifest with central nervous system (CNS) disorders in children.
- The human immunodeficiency virus (HIV), previously known as lymphadenopathy-associated virus (LAV) or human T-lymphotropic virus type III (HTLV-III), is the causative agent of AIDS.
- Progressive encephalopathy is a serious complication in children with AIDS.
Observation:
- Autopsy findings in 11 children with AIDS and progressive encephalopathy were analyzed.
- Neuropathologic examination revealed a unique pattern of CNS abnormalities.
- Patients ranged from 4 months to 11 years old, with most having LAV/HTLV-III antibodies or contaminated blood products.
Findings:
- Consistent findings included diminished brain weight, inflammatory cell infiltrates, multinucleated cells (including giant cells), vascular calcification, and white matter changes.
- Inflammatory and vascular lesions were predominantly observed in the basal ganglia and pons.
- Evidence of LAV/HTLV-III retroviral particles and genome was detected in brain tissue via electron microscopy and hybridization studies.
Implications:
- These findings characterize a specific neuropathologic disorder associated with pediatric AIDS.
- The study highlights the direct CNS impact of the LAV/HTLV-III virus.
- Understanding these neuropathologic changes is crucial for managing pediatric HIV/AIDS patients.
Abstract:
The neuropathologic findings in 11 children with a new CNS disorder that occurs in children with the acquired immunodeficiency syndrome (AIDS) and is postulated to be due to LAV/HTLV-III, the virus that causes AIDS, are reported. The children, who ranged in age from 4 months to 11 years, died of AIDS complicated by progressive encephalopathy. Ten of the children either had positive serum antibody for LAV/HTLV-III or had received blood products from donors later found to be antibody-positive. Examination of the brains of these children at autopsy revealed a unique constellation of findings, including varying degrees of diminished brain weight in all cases, inflammatory cell infiltrates in nine brains, multinucleated cells in eight, three of which also contained multinucleated giant cells, vascular calcification in ten, vascular and perivascular inflammation in five, and white matter changes in nine. Inflammatory and vascular lesions were most prominent in basal ganglia and pons. LAV/HTLV-III retroviral particles, associated with multinucleated giant cells, were observed in two brains on electron microscopic examination. These two and one additional brain had evidence of the LAV/HTLV-III genome by hybridization studies. Only one brain had a recognizable opportunistic infection.