HIV related neuropathologic changes in adult

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Brain    Spinal cord     Meninges    Peripheral nerve    Muscle    Definitions

Brain  Head

• Predominently diffuse

• HIV encephalitis

• HIV leukoencephalopathy

• Vacuolar leukoencephalopathy (can be diffuse or multifocal)

• Diffuse poliodystrophy

• Cerebral vasculitis including granulomatous angiitis

• Cytomegalovirus (CMV) encephlaitis

• Mycobacterium avium intracellular (MAI)

• Metabolic encephalopathies

• Predominently focal or multifocal

• Focal pontine leukoencephalopathy

• Olivary hypertrophy

• Progressive multifocal leukoencephalopathy (PML)

• Herpes simplex virus encephalitis

• Varicella-zoster leukoencephalitis

• Tuberculous brain abscess

• Neurosyphillis (meningovascular)

• Cerebral toxoplasmoais

• Crytococcosis

• Primary CNS lymphoma

• Secondary CNS lymphoma

• Kaposi sarcoma

Spinal cord  Head

• HIV myelitis

• Vacuolar myelopathy

• Herpes simplex or zoster myelitis

Meninges Head

• HIV meningitis (in the absence of demonstrable opportunistic infection)

• Cryptococcol meningitis

• Tuberculous meningitis

• Syphilitic meningitis

• Mycobacterium avium intracellular (MAI)

• Metastatic lymphomatous meningitis

• Kaposi sarcoma

Peripheral nerve  Head

• Infections

• Herpes zoster

• Cytomegalovirus polyradiculopathy

• HIV or immune related

• Acute inflammatory demyelinating (poly)(radiculo) neuropathy (HIV-associated)

• Chronic demyelinating (poly)(radiculo) neuropathy

• Axonal neuropathy (HIV-associated predominantly sensory)

• Ganglionitis, ganglioradiculitis, (poly)(radiculo) neuritis

• Necrotizing vasculitis, vasculitic neuropathy

Muscle  Head

• Polymyositis

• Necrotizing myopathy

• Nemaline rod myopathy

• Vesicular myopathy, mitochondrial myopathy

• Necrotizing vasculitis

Definitions: (Budka et al., Brain Pathol 1991 1:143-152) Head

HIV encephalitis and myelitis: It is defined as the presence of multiple disseminated foci composed of microglia, macrophages, and multinucleated giant cells (MCGs). If MCGs cannot be found, the presence of large amounts of HIV antigen or nucleic acid as determined by immunohistochemistry or in situ hybridization is required.

HIV leukoencephalopathy: In contrast to focal lesions of HIV encephalitis, it is defined as diffuse damage of the white matter including myelin loss, reactive astrocytosis, macrophages, and MGCs, but little or no inflammatory infiltrates. If MGCs cannot be found, the presence of large amounts of HIV antigen or nucleic acid as determined by immunohistochemistry or in situ hybridization is required.

Vacuolar leucoencephalopathy: It is defined morphologically by the presence of numerous vacuolar myelin swellings (vacuolar myelinopathy) and macrophages that are prominent in cerebral white matter. Some macrophages typically reside within vacuoles.

Vacuolar myelopathy: It is defined morphologically by the presence of multiple areas of the spinal cord, predominently in the dorsolateral spinal tracts, exhibiting numerous vacuolar myelin swellings (vacuolar myelinopathy) and macrophages. Some macrophages typically reside within vacuoles.

Diffuse poliodystrophy: It is defined as diffuse reactive astrogliosis and microglial activation involving the cerebral gray matter.