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1996-02-26
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Document 0246
DOCN M9620246
TI The neuropathology and epidemiology of AIDS. A Berlin experience. A
review of 200 cases.
DT 9602
AU Martinez AJ; Sell M; Mitrovics T; Stoltenburg-Didinger G; Iglesias-Rozas
JR; Giraldo-Velasquez MA; Gosztonyi G; Schneider V; Cervos-Navarro J;
Freie Universitat Berlin, Universitatsklinikum Benjamin; Franklin,
Germany.
SO Pathol Res Pract. 1995 Jun;191(5):427-43. Unique Identifier : AIDSLINE
MED/96015364
AB The brains of 200 patients who died with Acquired Immunodeficiency
Syndrome (AIDS) from Berlin were examined retrospectively. This study
was specifically intended to evaluate and document the prevalence of
neuropathologic abnormalities, establishing the frequency of the various
types of structural lesions, their combinations, their relative
incidence, and the risk factors involved in different age groups. The
data were compared and contrasted with the findings reported from other
parts of the world and other German cities. It was found that the mean
age of this group of patients was 41.4 years old, 75% were
homosexual/bisexuals (H/B) and 18.5% were drug abusers (DA). Only 5.5%
were women. Brain parenchymal changes, called in this report,
HIV-related encephalopathy (HIVRE), characterized by vacuolization or
spongy changes and astrocytosis in the subcortical white matter, and
occasionally in gray matter, were found in 67 patients (33.5%). Drug
abusers had a higher incidence of HIVRE (59.5%) compared with
homosexual/bisexuals (28%). This is statistically significant (p <
0.0005). CMV encephalitis was found in 26 patients (13%) (8% of the drug
abusers in contrast to 13% in the homosexual/bisexuals group). Primary
central nervous system lymphoma (PCNSL) was seen in 28 patients (14%)
regardless of the risk factor involved. 20 (13%) of the 150 H/B and 3
(8%) of the 37 DA had CMV encephalitis. Of the 150 H/B, 24 (16%) had
PCNSL compared with only 4 of 37 (11%) of the DA. A significant
incidence of opportunistic infections, both protozoal and viral was
found in all groups. Cerebral toxoplasmosis occurred in 68 patients
(34%). Microglial (phagocytic) nodules, probably related to CMV or
cerebral Toxoplasmosis, were observed in 40 cases (20%). Diffuse
microglial proliferation was noted in 104 patients (52%). Cerebral
cryptococcosis was found in three patients. Progressive multifocal
leukoencephalopathy was seen in 16 patients (8%). Various combinations
of CNS pathological processes were found in 44 of the patients (22%).
These include concomitant infections with Toxoplasma gondii and HIVRE in
13 patients; Toxoplasmosis and PCNSL in 8 patients; Toxoplasmosis with
CMV and HIVRE in 4 patients; Toxoplasmosis with CMV in 2 patients;
Toxoplasmosis with PCNSL and CMV in 2 patients; Toxoplasmosis with PCNSL
and HIVRE in 2 patients and Toxoplasmosis with PML and HIVRE in 2
patients; Cerebral CMV with PCNSL and HIVRE in 4 patients; Cerebral CMV
with HIVRE in 2 patients; PML with PCNSL in one patient; PML with HIVRE
in 2 patients; and PML with PCNSL and HIVRE in one patient.
Cerebrovascular lesions were found in 34 patients (17%).(ABSTRACT
TRUNCATED AT 400 WORDS)
DE Acquired Immunodeficiency Syndrome/COMPLICATIONS/EPIDEMIOLOGY/
*PATHOLOGY Adult Aged Aged, 80 and over AIDS Dementia
Complex/COMPLICATIONS/EPIDEMIOLOGY/*PATHOLOGY AIDS-Related
Opportunistic Infections/EPIDEMIOLOGY/ETIOLOGY/ PATHOLOGY
Berlin/EPIDEMIOLOGY Female Human Male Middle Age Retrospective
Studies Risk Factors Support, Non-U.S. Gov't JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).