HIV-1/AIDS neuropathology in a Canadian teaching centre.
BACKGROUND
The nervous system is a major target of HIV-1 infection and site of many complications of AIDS. Most of our knowledge pertaining to the range and frequency of neuropathology in HIV-1/AIDS is from large centres outside Canada in different social and health care settings. The goal of the present study was to describe HIV-1/AIDS-associated neuropathology before and during the era of highly active antiretroviral therapy at a Canadian teaching centre.


METHODS
The records of the Department of Pathology, London Health Sciences Centre were electronically searched for cases of HIV-1/AIDS that came to postmortem examination since 1985. The clinical records and pathological materials were reviewed.


RESULTS
Sixteen autopsies of HIV-1/AIDS were identified. All patients were male. Fourteen contracted HIV-1 through high risk homosexual activity, one through the transfusion of blood products and one through intravenous drug use. Three patients (19%) had pre-mortem evidence of HIV-1 associated dementia. At autopsy, 12 of the 16 cases had neuropathological findings and the most common diagnoses were HIV-1 encephalitis, progressive multifocal leukoencephalopathy, toxoplasmosis, and primary CNS lymphoma.


CONCLUSIONS
High risk homosexual activity was a more prominent factor in acquiring AIDS in cases coming to postmortem examination compared with previous reports from most larger urban centres outside Canada where injection drug use and high risk heterosexual activity factored prominently. The incidence of HIV-1 associated dementia was similar to that reported previously. This study confirms the heavy burden and wide spectrum of disease experienced by the nervous system in HIV-1/AIDS.
Walsh
Kimberley
K
Department of Pathology, London Health Sciences Centre, University of Western Ontario, Canada.
Thompson
William
W
Megyesi
Joseph
J
Wiley
Clayton A
CA
Hammond
Robert
R
D015526:AIDS Dementia Complex / Q000453:epidemiology* / Q000473:pathology; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000473:pathology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001344:Autopsy; D002493:Central Nervous System Diseases / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D006679:HIV Seropositivity; D015497:HIV-1; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies
D019380:Anti-HIV Agents