Neuropathology and general autopsy findings in AIDS during the last 15 years

A retrospective study of 450 consecutive AIDS autopsy cases (397 males, 53 females; mean age at death 38.4 years) in Vienna, Austria, between 1984 and 1999 compares the central nervous system (CNS) findings in three cohorts: 1984-1992 (190 cases), 1993-1995 (162 cases) and 1996-1999 (98 cases, after introduction of triple antiretroviral therapy) and the relationship of CNS findings to systemic AIDS pathology in the latter two cohorts. In these tw o groups, following involvement of the lung (85% and 75%, respectively), th e brain continued to be the second most frequently involved organ (decrease from 80% to 60%, respectively). Extracerebral protozoal (Pneumocystis cari nii, toxoplasmosis), Mycobacterium avium complex, viral [e.g., cytomegalovi rus (CMV)], multiple opportunistic organ and CNS infections, and Kaposi sar coma significantly decreased over time. There was less decrease in fungal i nfections, while bacterial organ and CNS infections (except for mycobacteri osis), lymphomas, HIV-associated CNS lesions (around 30%), non HIV-associat ed changes (vascular, metabolic, etc.) and negative CNS findings (10-11%) r emained unchanged. Nonspecific CNS changes (e.g., meningeal fibrosis) incre ased. Extracerebral pathology in subjects with advanced HIV-related CNS les ions showed more frequent but decreasing systemic bacterial and CMV infecti ons than those with negative or nonspecific neuropathology, while other opp ortunistic and multiple organ infections and lymphomas showed no difference s between both groups. In a cohort of drug abusers, HIV encephalitis, progr essive multifocal leukoencephalopathy, bacterial infections, hepatic enceph alopathy, and negative CNS findings were more frequent than in non-users wh o showed increased incidence of CMV, toxoplasmosis, or other opportunistic CNS infections, and nonspecific CNS findings; the frequency of lymphomas wa s similar in: both drug abusers and non-users. Similar to a recent autopsy study from San Diego, these data suggest that despite the beneficial effect s of modern antirenoviral combination therapy, involvement of the brain: in AIDS subjects continues to be a frequent autopsy finding, while the increa sed incidence of HIV encephalitis in our small cohort of drug users was les s than observed in other recent autopsy studies.