Related Experiment Videos
Neuropathology of acquired immunodeficiency syndrome (AIDS): an autopsy review
Abstract:
In the brains and spinal cords of 153 adult patients dying with acquired immunodeficiency syndrome (AIDS) at New York and Memorial Hospitals a subacute encephalitis with multinucleated cells was present in 28% of all patients. This encephalitis was characterized by multinucleated cells primarily located in the white matter and associated with myelin pallor and sparse infiltrates of rod cells, macrophages, gemistocytic astrocytes and lymphocytes. The incidence per 12 month period ranged from 0 to 43% and significantly increased between 1983-84 (14%) and 1984-85 (43%). Recent virologic and pathologic studies suggest that this encephalitis may be caused by direct LAV/HTLV-III infection of the central nervous system (CNS). Cytomegalovirus encephalomyelitis and toxoplasmosis were the most common opportunistic infections (26% and 10%, respectively). Progressive multifocal leukoencephalopathy, herpes simplex ventriculitis, varicella-zoster leukoencephalitis and fungal infections were infrequent (less than 3% each). A nonspecific encephalitis with microglial nodules and with mild white matter changes occurred in 17%, vacuolar myelopathy in 29% and CNS lymphoma in 6%. Less than 20% of patients had either normal brains or terminal metabolic encephalopathies. This survey shows that neuropathologic complications of AIDS are frequent. Infections are the most common complication and are caused by probable LAV/HTLV-III infection, or by opportunistic organisms.
Insights
Neuropathologic complications are frequent in acquired immunodeficiency syndrome (AIDS). A subacute encephalitis, possibly due to direct LAV/HTLV-III infection, increased significantly in incidence.
Area of Science:
- Neuropathology
- Infectious Diseases
- Central Nervous System (CNS) Disorders
Background:
- Acquired immunodeficiency syndrome (AIDS) is associated with frequent central nervous system (CNS) complications.
- Previous studies indicated various neuropathological findings in AIDS patients.
Purpose of the Study:
- To investigate the spectrum and incidence of neuropathologic complications in adult patients with AIDS.
- To characterize a specific subacute encephalitis observed in AIDS patients.
Main Methods:
- Autopsy examination of brains and spinal cords from 153 adult AIDS patients.
- Histopathological analysis to identify specific lesions and causative agents.
- Incidence rates were calculated and analyzed over time.
Main Results:
- A subacute encephalitis with multinucleated cells was found in 28% of patients, increasing from 14% to 43% between 1983-85.
- Opportunistic infections like Cytomegalovirus encephalomyelitis (26%) and toxoplasmosis (10%) were common.
- Other findings included vacuolar myelopathy (29%) and CNS lymphoma (6%).
Conclusions:
- Neuropathologic complications are a frequent and significant aspect of AIDS.
- Infections, potentially including direct LAV/HTLV-III CNS infection and opportunistic pathogens, are the primary cause of these complications.