CLINICOPATHOLOGICAL CORRELATIONS OF HIV-1-ASSOCIATED VACUOLAR MYELOPATHY - AN AUTOPSY-BASED CASE-CONTROL STUDY

To determine the clinical correlates of HTV-1-associated vacuolar myel opathy (VM), we designed a case-control study based on 215 AIDS autops ies in which we examined the spinal cord. We defined a case as an indi vidual dying with AIDS and with VM present at autopsy; we defined a co ntrol as an individual dying with AIDS without VM. VM was found in 100 of 215 (46.5%) autopsies, with no apparent temporal trends. A higher number of AIDS-defining illnesses was strongly associated with the lik elihood of VM (trend chi-square = 26.52, p < 0.001). Systemic infectio n with Mycobacterium avium-intracellulare and Pneumocystis carinii pne umonia were each associated with the pathologic findings of VM in both univariate and multivariate models. In the brain, multinucleated gian t cells were detected in more cases than in controls (odds ratio = 3.6 8, 95% CI = 1.73 to 7.47, p < 0.001). The clinical features of HIV-1 d ementia were not associated with VM; in contrast, predominantly sensor y neuropathy was more common in VM cases than in controls (odds ratio = 5.00, 95% CI = 1.35 to 18.5, p < 0.05). Fifty-six cases with VM had detailed neurologic evaluations, but only 15 (26.8%) had signs and sym ptoms of myelopathy. The presence of symptomatic myelopathy was relate d to the pathologic severity: none of 17 cases with grade 1, five of 2 6 with grade 2, and 10 of 13 with grade 3 had clinical features of mye lopathy (trend chi-square = 21.16, p < 0.005). VM is a common neuropat hologic finding that is frequently unrecognized during life. The assoc iation with the number of systemic illnesses, M avium-intracellulare i nfection, and P carinii pneumonia suggests that the development of VM is related to the severity of immunosuppression.