Spectrum of Autopsy HIV Neuropathology in a Minority Population in the Post Anti-Retroviral Therapy (ART) Era
Ming Zhang, Abir Mukherjee. Temple University Hospital, Philadelphia, PA
Background: Primary HIV associated parenchymal brain pathology (HIV encephalitis, leucoencephalopathy and microglial nodule encephalitis) and secondary opportunistic infections have declined in the post ART era. We have investigated the spectrum of autopsy HIV neuropathology and incidence of Alzheimer type neurodegeneration in a predominantly racial and ethnic minority population with multiple comorbidities.
Design: We retrospectively studied neuropathologic findings in 20 HIV positive autopsy cases (2008-2012) which were classified into two groups (with or without ART therapy). The neuropathologic findings were categorized into (1) primary parenchymal HIV associated brain pathology (2) secondary pathology associated with immunosupression (3) non specific neuropathologic changes (4) no significant neuropathologic changes. Tau and beta-amyloid immunostain were performed on hippocampus and neocortical sections to evaluate Alzheimer type neuropathologic changes.
Results: The cohort consisted of 12 African Americans, 6 Hispanics and 2 Caucasians. 9 patients were on ART therapy. Primary HIV associated parenchymal brain pathology was present in 4 cases (25%) (1 case with both leucoencephalopathy and microglial nodule encephalitis). Secondary neuropathologic changes was present in 6 cases (30%). Seven brains (35%) showed variety of changes unrelated to direct HIV infection. No significant pathology was found in 2 brains (10%). Beta-amyloid deposition was absecent in all the brains while neurofibrillary tangles were identified in hippocampus of two patients (Braak stage II and III).
|Categories||Sub-categories||With ART||Without ART|
|Primary HIV associated neuropathology|
|Microglial nodular encephalitis||1||3|
|Secondary neuropathology associated with immunosupression|
|Progressive multifocal encephalopathy||0||1|
|No significant neuropathology||1||1|
|Alzheimer type neurodegenerative changes|