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VII. HIV-Associated CNS disorders

CNS involvement may occur due to primary effects of HIV infection or to secondary effects of immune suppression. Between 10 and 20% of HIV-infected patients present with neurologic signs as their first clinical manifestation of infection. In some, no other signs of AIDS develop. Between 50 and 70% of all AIDS patients eventually develop some features of what is called AIDS dementia or the AIDS-related cognitive-motor complex. This term is used to describe the characteristic pattern of cognitive, motor, and behavioral dysfunction, including mood disturbances, seen in AIDS patients. At autopsy, between 60 and 90% of AIDS patients' brains show some form of pathology.

A. Pathologic Changes due directly to HIV infection

1. The pathology associated with the AIDS-related cognitive-motor complex, sometimes called subacute encephalitis, is located mainly in subcortical areas, with relative sparing of cerebral cortex.  Microscopic changes include:

  • diffuse white matter pallor
  • perivas­cular infiltrates of lymphocytes and macrophages
  • foci of necrosis, gliosis, and/or demyelination
  • microglial nodules, macro­phages and multi­nucleated cells