Important note: Information in this article was accurate in September 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, September 11, 2000
Prepared by AIDS Weekly editors from staff and other reports
NewsRx -- Researchers in Austria reported that central nervous system (CNS) involvement is still a frequent autopsy finding in AIDS patients irrespective of the introduction of improved antiretroviral therapies.
"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," wrote K.A. Jellinger and colleagues, Ludwig Boltzmann Institute of Clinical Neurobiology, Austria. "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)."
The researchers found that the following opportunistic infections decreased over time: extracerebral protozoal (Pneumocystis carinii, toxoplasmosis), Mycobacterium avium complex, viral [e.g., cytomegalovirus (CMV)], multiple opportunistic organ and CNS infections, and Kaposi's sarcoma.
Conversely, they found that there was less decrease in fungal infections, and 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%) actually remained the same over time. In fact, nonspecific CNS changes (e.g., meningeal fibrosis) actually increased, they said.
"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," wrote Jellinger et al. ("Neuropathology and general autopsy findings in AIDS during the last 15 years," Acta Neuropathol (Berl) 2000 Aug;100(2):213-20.
The researchers observed that HIV encephalitis, progressive multifocal leukoencephalopathy, bacterial infections, hepatic encephalopathy, and negative CNS findings were more frequent in a cohort of drug abusers than in non-users who showed increased incidence of CMV, toxoplasmosis, or other opportunistic CNS infections, and nonspecific CNS findings. However, the frequency of lymphomas was similar in both drug abusers and non-users.
"Similar to a recent autopsy study from San Diego, [California], 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," concluded Jellinger et al.
The contact person for this report is K.A. Jellinger, Ludwig Boltzmann Institute of Clinical Neurobiology, PKH-B BLdg, Baumgartner Hoehe 1, A-1140 Vienna, Austria.
Key points reported in this study are:
This article was prepared by AIDS Weekly editors from staff and other reports.
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