[1748] 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).

Table 1
CategoriesSub-categoriesWith ARTWithout ART
Race/ethnicity   
 White11
 Black48
 Hispanic42
Comorbidities   
 Hepatitis C12
 Hepatitis B21
Primary HIV associated neuropathology   
 HIV encephalitis00
 HIV leukoencephalopathy01
 Microglial nodular encephalitis13
Secondary neuropathology associated with immunosupression   
 Cryptococcus meningoencephaliltis04
 Aspergillous meningoencephalitis10
 Progressive multifocal encephalopathy01
Non-specific neuropathology 43
No significant neuropathology 11
Alzheimer type neurodegenerative changes   
 Beta-amyloid deposition00
 Neurofibrillary tangles11



Conclusions: Racial and ethnic minority population with HIV infection continue to have a high proportion of untreated cases, with high prevalence of both primary parenchymal HIV associated neruopathology as well as secondary opportunistic infections. However we did not find classical HIV encephalitis with multinucleate giant cells or Alzheimer type pneurodegenerative changes in our study.
Category: Neuropathology

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 267, Monday Morning

 

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