COMPARATIVE BRAIN PATHOLOGY OF HIV-SERONEGATIVE AND HIV-INFECTED DRUG-ADDICTS

Early stages of infection with human immunodeficiency virus (HIV) were studied in HIV-seropositive drug addicts. Since heroin users are immu nocompromized even in the absence of HIV infection, the aim of the pre sent study was to compare the morphological alterations present in HIV -seronegative and HIV-seropositive drug addicts. A total of 60 cases ( 32 HIV-seronegative subjects, 21 HIV-seropositive patients without sig ns of acquired immunodeficiency syndrome (AIDS), and 7 HIV-seropositiv e patients with signs of AIDS) were investigated macroscopically, hist ologically, and immunohistochemically. HIV-seronegative patients prese nted more frequently with acute drug intoxication, died at a significa ntly younger age than HIV-seropositive patients, and were found to suf fer more frequently from alcohol-related changes. These results indica ted that HIV-seronegative and HIV-seropositive patients differed possi bly in their drug consumption and also in their general conditions of life. In accordance with previous reports activated microglia and a di ffuse astrogliosis in the white matter were detected at a significantl y higher frequency and found to be more severe in HIV-seropositive sub jects than in HIV-seronegative addicts. A lymphocytic meningitis was p resent in 6 of 21 HIV-seropositive patients but in none of the HIV-ser onegative patients. Perivascular infiltrates consisting of lymphocytes and macrophages were detected at similar frequencies in HIV-seronegat ive and HIV-seropositive patients but were significantly more severe i n patients suffering from lymphocytic meningitis or purulent encephali tis. Opportunistic infections were only demonstrated in 2 AIDS cases. In 10 of the HIV-seronegative patients and in 3 of the HIV-seropositiv e patients CD68-and Ham56-positive multinucleated cells were detected scattered in the subarachnoidal space exclusively over the frontal cor tex.