THE NEUROPATHOLOGY AND EPIDEMIOLOGY OF AIDS - A BERLIN EXPERIENCE - AREVIEW OF 200 CASES

The brains of 200 patients who died with Acquired Immunodeficiency Syn drome (AIDS) from Berlin were examined retrospectively. This study was specifically intended to evaluate and document the prevalence of neur opathologic abnormalities, establishing the frequency of the various t ypes of structural lesions, their combinations, their relative inciden ce, and the risk factors involved in different age groups. The data we re compared and contrasted with the findings reported from other parts of the world and other German cities. It was found that the mean age of this group of patients was 41.4 years old, 75% were homosexual/bise xuals (H/B) and 18.5% were drug abusers (DA). Only 5.5% were women. Br ain parenchymal changes, called in this report, HIV-related encephalop athy (HIVRE), characterized by vacuolization or spongy changes and ast rocytosis in the subcortical white matter, and occasionally in gray ma tter, were found in 67 patients (33.5%). Drug abusers had a higher inc idence of HIVRE (59.5%) compared with homosexual/bisexuals (28%). This is statistically significant (p < 0.0005). CMV encephalitis was found in 26 patients (13%) (8% of the drug abusers in contrast to 13% in th e homosexual/bisexuals group). Primary central nervous system lymphoma (PCNSL) was seen in 28 patients (14%) regardless of the risk factor i nvolved. 20 (13%) of the 150 H/B and 3 (8%) of the 37 DA had CMV encep halitis. Of the 150 H/B, 24 (26%) had PCNSL compared with only 4 of 37 (11%) of the DA. A significant incidence of opportunistic infections, both protozoal and viral was found in all groups. Cerebral toxoplasmo sis occurred in 68 patients (34%). Microglial (phagocytic) nodules, pr obably related to CMV or cerebral Toxoplasmosis, were observed in 40 c ases (20%). Diffuse microglial proliferation was noted in 104 patients (52%). Cerebral cryptococcosis was found in three patients. Progressi ve multifocal leukoencephalopathy was seen in 16 patients (8%). Variou s combinations of CNS pathological processes were found in 44 of the p atients (22%). These include concomitant infections with Toxoplasma go ndii and HIVRE in 13 patients; Toxoplasmosis and PCNSL in 8 patients T oxoplasmosis with CMV and HIVRE in 4 patients; Toxoplasmosis with CMV in 2 patients: Toxoplasmosis with PCNSL and CMV in 2 patients; Toxopla smosis with PCNSL and HIVRE in 2 patients and Toxoplasmosis with PML a nd HIVRE in 2 patients; Cerebral CMV with PCNSL and HIVRE in 4 patient s; Cerebral CMV with HIVRE in 2 patients; PML with PCNSL in one patien t; PML with HIVRE in 2 patients; and PML with PCNSL and HIVRE in one p atient. Cerebrovascular lesions were found in 34 Patients (17%). Cereb ral ischemic anoxic changes, edema and diffuse vascular congestion wer e found in 7.5%, Bacterial infections without cellular reaction were s een in 7 patients. This study supplies interesting and important neuro pathological, epidemiological, demographic and sociological informatio n with Public Health implications.