Influence of risk group and zidovudine therapy on the development of HIV encephalitis and cognitive impairment in AIDS patients.
OBJECTIVE
To determine the associations between HIV encephalitis and other central nervous system (CNS) pathology, viral burden, cognitive impairment, zidovudine therapy and risk group in AIDS patients.


METHODS
Planned autopsy study in AIDS patients evaluated prospectively for numerous clinical parameters.


METHODS
Regional academic centre for clinical care and pathology examination of patients with HIV infection.


METHODS
Edinburgh cohort of HIV-positive patients prospectively assessed for cognitive impairment, immunosuppression and clinical course. Unbiased series of consecutive autopsies in 27 homosexual men and 39 drug-using patients with AIDS.


METHODS
Zidovudine therapy monitored in all patients.


METHODS
Determination of CNS viral burden and pathology including immunocytochemically confirmed HIV encephalitis in injecting drug users (IDU) versus homosexual AIDS patients with known CD4 counts and cognitive function.


RESULTS
HIV encephalitis was present in 59% of IDU and 15% of homosexuals: 88% of patients with encephalitis had displayed cognitive impairment. HIV encephalitis was strongly associated with a high viral load and HIV p24 immunopositivity. Opportunistic infections and lymphomas were more common in homosexuals (63%) than in IDU (31%) and were associated with the degree of immunosuppression before death. Within both groups, prolonged zidovudine treatment was associated with a lower incidence of HIV encephalitis.


CONCLUSIONS
This study documents two separate CNS outcomes in AIDS patients in that HIV encephalitis occurs independently of opportunistic infections and lymphomas and shows different associations with risk group, immunosuppression and antiviral treatment before death.
Bell
J E
JE
Department of Pathology, University of Edinburgh, UK.
Donaldson
Y K
YK
Lowrie
S
S
McKenzie
C A
CA
Elton
R A
RA
Chiswick
A
A
Brettle
R P
RP
Ironside
J W
JW
Simmonds
P
P
D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D017088:AIDS-Related Opportunistic Infections; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000523:psychology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003071:Cognition; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D018792:Encephalitis, Viral / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D005260:Female; D005625:Frontal Lobe / Q000821:virology; D016655:HIV Core Protein p24 / Q000032:analysis / Q000097:blood; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D016867:Immunocompromised Host; D016483:Lymphoma, AIDS-Related; D008297:Male; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D006113:United Kingdom; D015215:Zidovudine / Q000627:therapeutic use*
D000998:Antiviral Agents; D004279:DNA, Viral; D016655:HIV Core Protein p24; D015215:Zidovudine