HIV-ASSOCIATED BRAIN PATHOLOGY IN THE UNITED-KINGDOM - AN EPIDEMIOLOGIC-STUDY

Objectives: To examine the epidemiology of HIV-associated neuropatholo gy in the United Kingdom and to investigate whether the prevalence of different forms of HIV-associated brain pathology varies with exposure category. Design: The study was a cross-sectional survey; data was an alysed from the Medical Research Council National AIDS Neuropathology database. Setting: Information was gathered from throughout England, S cotland and Wales.Subjects: Individuals who died from AIDS in the Unit ed Kingdom and had a postmortem examination. The database comprised 7% of all AIDS deaths in the United Kingdom between 1982 and 1993. Main outcome: Neuropathological diagnoses based on internationally accepted neuropathological terminology of AIDS-related brain lesions. Results: HIV encephalitis was the most prevalent pathological diagnosis, occur ring in 25.3% [95% confidence interval (CI), 27.0-29.6] of the study s ample. Statistically significant independent associations for the occu rrence of HIV encephalitis were found for injecting drug use (odds rat io, 6.86; 95% CI, 2.91-16.17), and age less than 30 years at death (od ds ratio, 3.58; 95% CI, 1.99-6.44). Vascular lesions were significantl y higher among blood product recipients, 95% of whom were haemophiliac s. Conclusions: This was the first epidemiological investigation of HI V-associated brain pathology in the United Kingdom. HIV encephalitis a ppeared to occur more Frequently in injecting drug users and those who died younger. Whereas the findings must be interpreted cautiously, on e hypothesis was that differences in the route of transmission may hav e affected the manifestation of HIV-associated brain damage.