Ocular pathology in NeuroAIDS - An autopsy study

Area of Science:

• Neuroscience
• Ophthalmology
• Infectious Diseases

Background:

• The central nervous system (CNS) and eyes are affected in Human Immunodeficiency Virus (HIV) related diseases.
• The optic nerve, an extension of the CNS, requires systematic evaluation for CNS-to-eye or eye-to-CNS infection spread in NeuroAIDS.

Purpose of the Study:

• To investigate the extent of ocular involvement in NeuroAIDS.
• To determine the concordance between CNS and ocular pathologies in NeuroAIDS.
• To evaluate the diagnostic utility of multiplex PCR in vitreous, cerebrospinal fluid (CSF), and serum for opportunistic infections.

Main Methods:

• Autopsy-retrieved brain and posterior eyeball compartments from NeuroAIDS patients were analyzed using Hematoxylin & Eosin, special stains, and immunohistochemistry.
• Multiplex PCR was employed for simultaneous detection of bacterial, viral, and protozoal opportunistic infections in vitreous, CSF, and serum.

Main Results:

• Ocular involvement was observed in 93.7% of NeuroAIDS cases.
• Opportunistic infections were the most common cause (62.5%), including toxoplasma optic neuropathy (50%), Cryptococcal optic neuritis (30%), and Cytomegalovirus chorioretinitis (20%).
• Concordance between ocular and CNS pathology was found in 50% of cases, with CSF PCR demonstrating higher sensitivity than vitreous PCR.

Conclusions:

• Ocular complications are highly prevalent in NeuroAIDS.
• Opportunistic infections are a major cause of ocular pathology in NeuroAIDS.
• CSF PCR is a more sensitive method than vitreous PCR for diagnosing posterior ocular infections in NeuroAIDS.