Brew B J, Rosenblum M, Cronin K, Price R W
Department of Neurology, St. Vincent's Hospital, Sydney, Australia.
Ann Neurol. 1995 Oct;38(4):563-70. doi: 10.1002/ana.410380404.
To evaluate the presence and distribution of central nervous system infection by human immunodeficiency virus type 1 (HIV-1), we used immunohistochemical methods to map the HIV-1 p24 core protein in the brains of 55 autopsied patients with acquired immunodeficiency syndrome (AIDS). In a subset of 40 of these patients who had undergone antemortem neurological evaluation of the AIDS dementia complex (ADC), we analyzed the relation between the severities of the viral infection and clinical dysfunction. Viral antigen was detected in macrophages and cells with morphological and immunohistochemical characteristics of microglia as well as multinucleated cells. The distribution of antigen-positive cells preferentially involved certain deep brain structures, especially the globus pallidus, other basal ganglia nuclei, and the central white matter. Overall, the presence and frequency of infected cells were highly correlated with the histological findings of multinucleated-cell encephalitis and in general with the clinical ADC stage. However, infection was often more limited than might be "anticipated" from the severity of patients' clinical dysfunction: Only 61% of patients with at least ADC stage 1 had detectable antigen and of these only approximately 30% of the brain sections were antigen positive. These results suggest a pathogenetic model of ADC where virus- or cell-coded toxins amplify the effect of limited brain infection.
为评估1型人类免疫缺陷病毒（HIV-1）引起的中枢神经系统感染的存在情况及分布，我们采用免疫组化方法对55例获得性免疫缺陷综合征（AIDS）尸检患者脑内的HIV-1 p24核心蛋白进行定位。在其中40例生前接受过AIDS痴呆综合征（ADC）神经学评估的患者亚组中，我们分析了病毒感染严重程度与临床功能障碍之间的关系。在巨噬细胞以及具有小胶质细胞形态学和免疫组化特征的细胞及多核细胞中检测到病毒抗原。抗原阳性细胞的分布优先累及某些脑深部结构，尤其是苍白球、其他基底神经节核团及中央白质。总体而言，感染细胞的存在及频率与多核细胞性脑炎的组织学表现高度相关，并且总体上与临床ADC分期相关。然而，感染程度往往比根据患者临床功能障碍严重程度“预期”的要更局限：在至少处于ADC 1期的患者中，只有61%可检测到抗原，并且在这些患者中，只有约30%的脑切片抗原呈阳性。这些结果提示了一种ADC的发病机制模型，即病毒或细胞编码的毒素放大了有限脑感染的影响。
