Autoptic findings in HIV-1 positive children
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Published on: December 20, 2024
T Masini1, D Chinaglia, P Ghidoni
1Institute of Pathology, University of Milan, Italy.
Insights
Congenital AIDS in children results from maternal HIV. Autopsies revealed opportunistic infections and specific brain changes like HIV-encephalopathy, distinct from non-specific leukoencephalopathy.
Area of Science:
- Pediatric Infectious Diseases
- Neuropathology
- Congenital Infections
Background:
- Rising Acquired Immunodeficiency Syndrome (AIDS) incidence in women is linked to increased pediatric AIDS cases.
- Congenital Human Immunodeficiency Virus (HIV) infection poses significant risks to newborns and children.
Purpose of the Study:
- To investigate the neuropathological findings in children with congenital AIDS.
- To differentiate between HIV-specific lesions and opportunistic infections in the central nervous system (CNS).
- To identify risk factors associated with congenital AIDS.
Main Methods:
- Autopsy examination of brain and internal organs from 14 children and 1 fetus with confirmed AIDS.
- Morphological, immunohistochemical, and in situ hybridization techniques were employed.
- Clinical data, including parental history, were reviewed.
Main Results:
- Opportunistic infections were prevalent in extracerebral organs.
- Cerebral findings included HIV-encephalopathy, cytomegalovirus encephalitis, vascular alterations, calcifications, and edema.
- Neurologic symptoms, such as drug withdrawal, were observed in children of intravenous drug-abusing mothers.
Conclusions:
- Maternal HIV positivity, particularly in intravenous drug users, is the primary risk factor for congenital AIDS.
- HIV encephalopathy is a late CNS manifestation, resulting from infected macrophages, not direct neuronal infection.
- Distinguishing between opportunistic and HIV-specific CNS lesions is crucial for accurate diagnosis and management.
Abstract:
The growing incidence of AIDS in children and newborns has been related to increasing incidence of AIDS in women. Case records were composed by 14 children with death occurring at different ages--from 1 hour to 12 years--and 1 female fetus, all with serological confirmation of AIDS. Brain and internal organs samples were collected at autopsy for morphological, immunohistochemical and "in situ" hybridization's technical examination. The prevailing extracerebral pathology observed at autopsy consisted of opportunistic infections. The cerebral findings were HIV-encephalopathy; cytomegalovirus encephalitis; vascular alterations such as necrosis and hemorrhage; calcifications and edema. Neurologic symptoms were reported in 3 children of intravenous drug-abuser mothers as drug withdrawal syndrome. HIV positivity in one or both the intravenous drug-abuser parents is the main risk factor of congenital AIDS. This factor means lack of care during the gestational stage and may determine relevant differences in the course of disease. The cerebral changes due to opportunistic infection must be differentiated from HIV-specific lesions; it has to be stressed that "diffuse" leukoencephalopathy is not AIDS-specific but can be found in every chronic encephalitis/encephalopathy especially in newborns and children. Chronologically, HIV encephalopathy appears as late manifestation of the disease, due to an infiltration of CNS of HIV-infected macrophages and not to an impairment of neuronal or glial cells infected by HIV in the early stages of the disease.
