Wiley C A, Nelson J A
Department of Pathology, University of California, San Diego.
Am J Pathol. 1988 Oct;133(1):73-81.
Approximately half of patients with advanced acquired immune deficiency syndrome (AIDS) develop a subcortical dementia. The brains of all autopsies on AIDS patients performed at UCSD between 1982 and 1986 (N = 93) were studied. Neuropathologic changes consistent with a viral encephalitis were present in 54 brains (58%). Human immunodeficiency virus (HIV) antigens were detected in 37 of the brains (40%), most frequently in macrophages, multinucleated giant cells, and endothelial cells. Cytomegalovirus (CMV) was detected in 31 of the brains (33%), 22 of which also contained HIV. Cellular localization of CMV antigens suggests that CMV disseminates to the central nervous system hematogenously where the virus can infect endothelial cells, glia, and neurons. While the temporal course of the appearance of these two viruses within the CNS is not clear, the common simultaneous occurrence of both viruses within the brains of AIDS patients suggests that in vivo interaction between them may play a role in the pathogenesis of AIDS-associated encephalitis. Given the significant neurologic symptoms described in AIDS patients, the paucity of viral antigens suggests a pathogenic mechanism of indirect CNS damage rather than direct viral infection.
约半数晚期获得性免疫缺陷综合征（AIDS）患者会出现皮质下痴呆。对1982年至1986年间在加州大学圣地亚哥分校进行尸检的所有AIDS患者的大脑（N = 93）进行了研究。54例大脑（58%）存在与病毒性脑炎一致的神经病理变化。在37例大脑（40%）中检测到人类免疫缺陷病毒（HIV）抗原，最常见于巨噬细胞、多核巨细胞和内皮细胞。在31例大脑（33%）中检测到巨细胞病毒（CMV），其中22例也含有HIV。CMV抗原的细胞定位表明，CMV通过血液传播至中枢神经系统，在那里病毒可感染内皮细胞、神经胶质细胞和神经元。虽然这两种病毒在中枢神经系统内出现的时间进程尚不清楚，但在AIDS患者大脑中这两种病毒常见的同时存在表明，它们之间的体内相互作用可能在AIDS相关脑炎的发病机制中起作用。鉴于AIDS患者出现明显的神经症状，病毒抗原的缺乏提示中枢神经系统间接损伤而非直接病毒感染的致病机制。
