Budka H
Neurological Institute, University of Vienna, Wien, Austria.
Brain Pathol. 1991 Apr;1(3):163-75. doi: 10.1111/j.1750-3639.1991.tb00656.x.
Neuropathology has defined novel HIV-specific diseases at tissue level: HIV encephalitis and HIV leukoencephalopathy. Both occur usually in the later stages of the AIDS infection and consistently demonstrate large amounts of HIV products. In contrast to this HIV-specific neuropathology, HIV-associated neuropathology features unspecific syndromes with disputed relation to HIV infection: myelin pallor, vacuolar myelopathy, vacuolar leukoencephalopathy, lymphocytic meningitis, and diffuse poliodystrophy. All types of neuropathology may contribute to clinical manifestation according to severity, extent, and distribution of lesions, but clinico-pathologic correlation may be poor in the individual case. Neuropathologic and other data suggest two major pathogenetic pathways of HIV-associated CNS damage: First, systemic and local increase of the virus load leads to HIV encephalitis or HIV leukoencephalopathy; this is corroborated by prominent HIV production within such lesions. Second, neuronotoxicity by HIV proteins or factors secreted from infected cells is supported by histological changes of diffuse poliodystrophy and by morphometric loss of frontocortical neurons.
神经病理学已在组织水平上明确了新型的HIV特异性疾病：HIV脑炎和HIV白质脑病。两者通常都发生在艾滋病感染的后期，并且始终显示出大量的HIV产物。与这种HIV特异性神经病理学不同，HIV相关神经病理学的特征是与HIV感染关系存在争议的非特异性综合征：髓鞘苍白、空泡性脊髓病、空泡性白质脑病、淋巴细胞性脑膜炎和弥漫性灰质营养不良。所有类型的神经病理学都可能根据病变的严重程度、范围和分布对临床表现产生影响，但在个别病例中临床病理相关性可能较差。神经病理学和其他数据表明，HIV相关中枢神经系统损伤有两条主要的发病途径：第一，病毒载量的全身和局部增加导致HIV脑炎或HIV白质脑病；此类病变中显著的HIV产生证实了这一点。第二，HIV蛋白或受感染细胞分泌的因子的神经毒性作用得到弥漫性灰质营养不良的组织学变化以及额叶皮质神经元形态计量学损失的支持。
