HUMAN-IMMUNODEFICIENCY-VIRUS AND THE BRAIN - INVESTIGATION OF VIRUS LOAD AND NEUROPATHOLOGIC CHANGES IN PRE-AIDS SUBJECTS

Brain tissue was examined for evidence of human immunodeficiency virus (HIV) infection in 23 intravenous drug users who died suddenly some y ears after seroconversion but while still in presymptomatic stages of infection. None showed giant cell encephalitis, but 14 showed T cell l ymphocytic leptomeningitis and 3 showed other significant neuropatholo gic features. Quantitative polymerase chain reaction for HIV was appli ed to 13 of the 23 with negative results in 6 and very low positive re sults in the other 7, a finding consistent with contamination by resid ual infected blood in the brain tissue. This contrasted with findings in AIDS-infected tissue, in which substantial amounts of provirus were found. It is concluded that significant infection in brain tissue doe s not occur in presymptomatic stages of HIV infection and that invasio n of the central nervous system may be delayed until the transition to symptomatic AIDS.