Kibayashi K, Mastri A R, Hirsch C S
Office of Chief Medical Examiner of the City of New York, NY 10016-6402, USA.
Hum Pathol. 1996 Jul;27(7):637-42. doi: 10.1016/s0046-8177(96)90391-3.
The authors studied the brains of 471 adults infected with human immunodeficiency virus type 1 (HIV-1): 123 asymptomatic carriers, 127 in an early stage of acquired immunodeficiency syndrome (AIDS) with pulmonary tuberculosis or bacterial infections, and 221 in fully developed AIDS with opportunistic infections or neoplasms. Lymphocyte infiltration of the leptomeninges and of perivascular spaces occurred at all stages, but the frequency was significantly higher in asymptomatic carriers. Microglial nodules appeared at all stages of disease; they were not an early indicator of HIV encephalitis (HIVE). The incidence of HIVE was unrelated to the stage of AIDS, suggesting that HIVE occurs before opportunistic infections and neoplasms. Drug abuse, such as cocaine and opiates, may enhance HIV replication and increase the incidence of HIVE in the early stage of AIDS. Opportunistic infections or lymphoma involved only the brain in 31.2% of persons with fully developed AIDS. Conversely, opportunistic infections or neoplasms involved only organs other than the brain in 55.7% of persons with fully developed AIDS. In 13.1% of persons with fully developed AIDS, opportunistic infections or neoplasms involved the brain and other organs. Multiple intracranial opportunistic infections and lymphoma coexisted in 4.1% of persons with fully developed AIDS. The authors identified cerebrovascular disease in 10.6% of asymptomatic carriers, 7.1% of early AIDS, and 5.0% of fully developed AIDS. The observed sequence of abnormalities may be useful in understanding the progression of HIV disease in the brain.
作者研究了471名感染1型人类免疫缺陷病毒（HIV-1）的成年人的大脑：123名无症状携带者，127名处于获得性免疫缺陷综合征（AIDS）早期且患有肺结核或细菌感染，以及221名患有机会性感染或肿瘤的完全型AIDS患者。软脑膜和血管周围间隙的淋巴细胞浸润在所有阶段均有发生，但在无症状携带者中频率显著更高。小胶质结节出现在疾病的各个阶段；它们并非HIV脑炎（HIVE）的早期指标。HIVE的发生率与AIDS阶段无关，这表明HIVE发生在机会性感染和肿瘤之前。药物滥用，如可卡因和阿片类药物，可能会增强HIV复制并增加AIDS早期HIVE的发生率。在完全型AIDS患者中，31.2%的患者机会性感染或淋巴瘤仅累及脑部。相反，在完全型AIDS患者中，55.7%的患者机会性感染或肿瘤仅累及脑部以外的器官。在13.1%的完全型AIDS患者中，机会性感染或肿瘤累及脑部和其他器官。在4.1%的完全型AIDS患者中，颅内多种机会性感染和淋巴瘤并存。作者在10.6%的无症状携带者、7.1%的早期AIDS患者和5.0%的完全型AIDS患者中发现了脑血管疾病。观察到的异常顺序可能有助于理解HIV疾病在大脑中的进展。
