PROFILE OF CENTRAL-NERVOUS-SYSTEM PATHOLOGY IN PATIENTS WITH AIDS - AN AUTOPSY STUDY FROM INDIA

Objective: To study the spectrum of neuropathological brain lesions in HIV/AIDS cases. Design: Retrospective autopsy study between 1988 and mid-1996 at a tertiary level public hospital. Methods: Eighty-five adu lt brains, with at least 21 sections from each, were examined using ro utine and special stains. Results: Risk factors in 64 men (75%) and 21 women (25%) included heterosexual contact with multiple sexual partne rs (83 cases, 98%), homosexual behaviour (one case, 1%) and blood tran sfusion (one case, 1%). Central nervous system (CNS) lesions were obse rved in 67 cases (79%). Opportunistic infections were present in 33 ca ses (39%), which included toxoplasmosis (11 cases, 13%), tuberculosis (10 cases, 12%), cryptococcosis (seven cases, 8%), and cytomegalovirus infection (six cases, 7%). Multifocal myelin loss was observed in 18 cases (21%), microglial nodules in 15 cases (18%), and angiocentric pa llor in five cases (6%). Infarcts/haemorrhages were present in 13 case s (15%), choroid plexitis in 21 cases (25%), lymphocytic meningitis wi thout opportunistic infection in 21 cases (25%), and calcification in four cases (5%). A dual infectious pathology was observed in one case (1%). Multinucleated giant cells and primary CNS lymphoma were not fou nd in any of our cases. Conclusions: Patient profile and risk factors for AIDS in India differ from those reported in industrialized countri es. Although not reported from India in the pre-AIDS era, toxoplasmosi s was the most frequently observed CNS opportunistic infection in our study. CNS tuberculosis is frequently observed in Indian AIDS cases co mpared with reports from industrialized countries where its occurrence is uncommon. Death due to systemic opportunistic infections may punct uate the course of HIV encephalitis and prevent its full-blown morphol ogical expression.