Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV Autopsy Cohort.
OBJECTIVE
Autopsy series of patients with AIDS have found a 4% to 29% prevalence of cerebral infarction. Little is known of the prevalence of cerebral infarction when not associated with non-HIV central nervous system (CNS) infection, lymphoma, or cardioembolic sources. Clinical correlation has seldom been available. We describe the pathological and clinical features of patients from the Edinburgh HIV Cohort Study found to have had cerebral infarcts without evidence of non-HIV CNS infection, CNS lymphoma, or cardioembolic sources at autopsy.


METHODS
From 183 autopsy cases, 26 without evidence of opportunistic cerebral infection or lymphoma were selected. These 26 cases went through a second selection process in which the presence of cerebral infarction, in the absence of the conditions mentioned, was verified. Histology and clinical records for the remaining patients were reviewed.


RESULTS
Ten (5.5%) cases fulfilled the inclusion criteria and demonstrated similar hypoxic-ischemic lesions. Small-vessel thickening was seen in all cases, and perivascular space dilatation, rarefaction, and pigment deposition, with vessel wall mineralization and perivascular inflammatory cell infiltrates, were seen in some cases. Vasculitis was not found. One patient had had a transient ischemic attack, and no patient had had a stroke.


CONCLUSIONS
Cerebral infarcts in HIV-infected patients are not common in the absence of cerebral non-HIV infection, lymphoma, or embolic sources. We found an HIV-associated vasculopathy with similar features in all risk groups. In AIDS patients presenting with stroke or transient ischemic attack, potentially treatable causes, such as cerebral coinfection or tumor, should be sought.
Connor
M D
MD
Neurology Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Lammie
G A
GA
Bell
J E
JE
Warlow
C P
CP
Simmonds
P
P
Brettle
R D
RD
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000473:pathology; D000328:Adult; D001344:Autopsy; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000821:virology; D020520:Brain Infarction / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D005625:Frontal Lobe / Q000821:virology; D016655:HIV Core Protein p24 / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology; D019562:Viral Load
D016655:HIV Core Protein p24