HIV related neuropathologic changes in children

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Brain    Spinal cord     Comment

Brain  Head

• Parenchymal changes

• HIV encephalitis

• HIV leucoencephalopathy

• Myelin loss

• Microcephaly and brain atrophy

• Basal ganglia mineralization

• Vascular changes

• Vasculitis (small arteries and venues)

• Vasculopathy (medium to larger arteries)

• Hemorrhages

• Infarcts/Leigh disease-like changes

• Infections

• CMV encephalitis

• Measles encephalitis

• Adenovirus encephalitis

• Mycobacterium avium intracellular (MAI)

• Aspergillosis

• Toxoplasmosis

• Neoplasm

• Lymphomas

Spinal cord  Head

• HIV myelitis

• Cortico-spinal tract degeneration

• Vacuolar myelopathy

Comments: Head

HIV leucoencephalopathy: this refers to condition characterized by the presence of multinucleated giant cells, a relatively diffuse form of myelin loss, reactive gliosis, and little or no inflammation.

Myelin loss: this is seen in over 50% of cases and range from focal myelin loss, usually associated with foci of inflammation (HIV encephalitis), to diffuse myelin pallor with gliosis involving central and gyral myelin.

Microcephaly and brain atrophy: brain atrophy is seen in over half of all pediatric CNS HIV cases. Microcephaly and brain atrophy, however, do not necessary to co-exist with HIV encephalitis.

Basal ganglia mineralization: mineralizations are present as parenchymal deposits (calcospherites) or as vascular deposits (calcific vasopathy or small blood vessels) in basal ganglia. In many cases, there are enough calcium to be detected by CT scan. Kids with such depositions characteristically loss the ability to walk, acquired during the earlier course of the disease, and with progressive neurologic deterioration.

Vasculitis: vasculitis and perivasculitis affect primarily small parenchymal arteries and small venules. In addition to lymphocytic infiltration, multinucleated giant cells may be seen in the adjacent parenchyma. Usually associated with encephalitis but may exist as an independent condition. It can co-exist with vasculopathy. In contrast to vasculopathy, vasculitis is seen only in the brain.

Vaculopathy: usually the medium to large arteries are affected. Histologically, there is intimal fibroblastic proliferation, perivascular fibrosis, and fragmentation of elastic lamina, sometimes with aneurysmal dilatation and endothelial cell hypertrophy. It appears to be a part of a process of the systemic vasculopathy involving small- and medium sized arteries in many internal organs.