Neuropathology and general autopsy findings in AIDS during the last 15 years |
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Authors: | K A Jellinger U Setinek M Drlicek G Böhm A Steurer F Lintner |
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Institution: | (1) Ludwig Boltzmann Institute of Clinical Neurobiology, PKH/B-Building, Baumgartner Hoehe 1, 1140 Vienna, Austria e-mail: kurt.jellinger@univie.ac.at, Tel.: +43-1-9106014244 or 24244, Fax: +43-1-9106049862, AT;(2) Institute of Pathology and Bacteriology, Baumgartner Hoehe 1, 1140 Vienna, Austria, AT;(3) Institute of Pathology, Wagner Jauregg Hospital for Neurology and Psychiatry, Wagner Jauregg-Weg 15, 4010 Linz, Austria, AT;(4) Department of Pulmology II, Sanatoriumstrasse 1, 1140 Vienna, Austria, AT |
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Abstract: | A retrospective study of 450 consecutive AIDS autopsy cases (397 males, 53 females; mean age at death 38.4 years) in Vienna,
Austria, between 1984 and 1999 compares the central nervous system (CNS) findings in three cohorts: 1984–1992 (190 cases),
1993–1995 (162 cases) and 1996–1999 (98 cases, after introduction of triple antiretroviral therapy) and the relationship of
CNS findings to systemic AIDS pathology in the latter two cohorts. In these two groups, following involvement of the lung
(85% and 75%, respectively), the brain continued to be the second most frequently involved organ (decrease from 80% to 60%,
respectively). Extracerebral protozoal (Pneumocystis carinii, toxoplasmosis), Mycobacterium avium complex, viral e.g., cytomegalovirus (CMV)], multiple opportunistic organ and CNS infections, and Kaposi sarcoma significantly
decreased over time. There was less decrease in fungal infections, while bacterial organ and CNS infections (except for mycobacteriosis),
lymphomas, HIV-associated CNS lesions (around 30%), non HIV-associated changes (vascular, metabolic, etc.) and negative CNS
findings (10–11%) remained unchanged. Nonspecific CNS changes (e.g., meningeal fibrosis) increased. Extracerebral pathology
in subjects with advanced HIV-related CNS lesions showed more frequent but decreasing systemic bacterial and CMV infections
than those with negative or nonspecific neuropathology, while other opportunistic and multiple organ infections and lymphomas
showed no differences between both groups. In a cohort of drug abusers, HIV encephalitis, progressive multifocal leukoencephalopathy,
bacterial infections, hepatic encephalopathy, and negative CNS findings were more frequent than in non-users who showed increased
incidence of CMV, toxoplasmosis, or other opportunistic CNS infections, and nonspecific CNS findings; the frequency of lymphomas
was similar in both drug abusers and non-users. Similar to a recent autopsy study from San Diego, these data suggest that
despite the beneficial effects of modern antiretroviral combination therapy, involvement of the brain in AIDS subjects continues
to be a frequent autopsy finding, while the increased incidence of HIV encephalitis in our small cohort of drug users was
less than observed in other recent autopsy studies.
Received: 7 March 2000 / Revised, accepted: 24 March 2000 |
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Keywords: | AIDS Extracerebral pathology Central nervous system lesions Opportunistic infections |
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