The Neuropathology of HIV Infection

A multi-author approach is taken in this book to give a thorough view of the neuropathology of AIDS. The authors have exhaustively reviewed all the available data in order to draw a clear and complete picture of the present status. The broad approach makes the reader aware that the neurological disease is part of a process involving the patients in their entirety.

1 HIV Infection: A Cellular Approach.- The Human Immunodeficiency Viruses.- Structure of HIV and Viral Protein Products.- Simian Immunodeficiency Viruses.- Use of the SIV Model.- Strain Variations of HIV.- Cellular Tropism of HIV.- Pathogenesis of HIV Infection.- Direct Cytopathic Effect of CD4-Positive Cells.- Direct Infection of CD4-Negative Cells.- Infection of Monocytes/Macrophages.- Contribution of Other Infectious Co-factors.- Immune Response to Infected Cells.- 2 Epidemiology and Natural History of HIV Infection: An Overview.- Definition.- Modes of Transmission of HIV.- Global Epidemiology.- Natural History of Infection: Classification.- Centers for Disease Control (CDC) Classification System for HIV Infection.- Progression to Symptomatic Disease.- Natural History of Infection: Clinical Aspects.- Prognostic Laboratory Markers.- Tumours.- Kaposi’s Sarcoma.- Lymphoma.- Opportunistic Infections.- Pulmonary Complications.- Gastrointestinal and Hepatic Complications.- Neurological Complications.- Conclusions.- 3 Neurological Complications of HIV Infection: Clinical Aspects.- Seroconversion Illness.- Asymptomatic Period.- HIV Meningitis.- Peripheral Neuropathy.- Myopathy/Polymyositis.- ARC/AIDS.- Mononeuritis Multiplex.- Myelopathy.- PeripheraINeuropathy.- Encephalopathy.- Cerebrovascular Disease.- Myopathy.- Opportunistic Infections.- Parasites.- Fungi.- Viruses.- Spirochaetes/Bacteria.- Tumours.- Paediatric AIDS.- 4 Acquired Immune Deficiency: Neuroradiological Imaging.- Pre-seroconversion.- Seroconversion to HIV-Positive.- AIDS.- Cytomegalovirus Infection.- Progressive Multifocal Leukoencephalopathy.- Varicella Zoster Infection.- Herpes Simplex Infection.- Toxoplasmosis.- Fungal Infections.- Other Infections.- B-Cell Lymphomas.- Strokes.- Paediatric AIDS.- Response to Therapy.- Imaging Methods.- Imaging Abnormalities.- Intracranial Lesions.- Myelopathy.- Head and Neck Disease.- 5 General Pathology.- Lymphoreticular System.- Lymph Nodes.- Neoplasms.- Opportunistic Infections of Lymph Nodes.- Spleen.- Bone Marrow.- Other Sites.- Skin.- Non-infectious Disorders.- Infectious Diseases.- Neoplasms.- Respiratory System.- Pneumocystis carinii Pneumonia.- Cytomegalovirus Pneumonitis.- Other Types of Pneumonitis.- Neoplasms.- Cardiovascular System.- Alimentary System.- Mouth and Pharynx.- Oesophagus and Stomach.- Intestinal Tract.- Hepatopancreatic System.- Anorectum.- Genito-urinary System.- Endocrine System.- 6 Pathology of the Nervous System.- Infections of the Central Nervous System by HIV.- Neuropathology.- Opportunistic Infections: Viral.- Cytomegalovirus Encephalitis.- Progressive Multifocal Leukoencephalopathy.- Herpes Simplex Virus.- Varicella Zoster Virus.- Opportunistic Infections: Fungal.- Cryptococcosis.- Aspergillosis.- Candidosis.- Coccidioidomycosis.- Other Mycoses.- Opportunistic Infections: Protozoal.- Toxoplasmosis.- Other Protozoal Infections.- Opportunistic Infections: Bacterial.- M. tuberculosis.- Atypical Mycobacteria.- Other Bacterial Infections.- Cerebrovascular Disorders.- Neoplasms of the Central Nervous System.- Non-Hodgkin’s Lymphomas.- Hodgkin’s Disease.- Lymphomatoid Granulomatosis.- Kaposi’s Sarcoma.- Other Lesions.- Lesions of the Pituitary Gland.- Multiple Intracranial Lesions.- Haemophilia and AIDS.- Brain Biopsy.- Appendix. Morphological Demonstration of Infectious Organisms Within the CNS in AIDS.- Tissue Preparation.- Rapid Preparations.- Bacteria and Fungi.- Protozoa.- Viruses.- Detection of Viral DNA by In Situ Hybridization with Biotinylated DNA Probes.- HIV.- Modified Avidin-Biotin Immunohistochemical Method, for HIV.- 7 HIV-Related Dementia: Pathology and Possible Pathogenesis.- Incidence and Definition of HIV-Related Dementia.- HIV-Associated Neuropathology.- HIV-Specific Central Nervous System Pathology.- HIV-Associated (Possibly HIV-Induced) Central Nervous System Changes.- Clinico-neuropathological Correlation.- Neuroradiological-Neuropathological Correlation.- Pathogenesis.- Cellular Tropism of HIV in the Nervous System.- Development of the N’ervous Tissue Lesion by HIV: The Role of the Virus Load.- Indirect Mechanisms of Damage.- Special HIV Variants in the Nervous System.- Contributory Role of Opportunistic Infections.- Immune Pathogenesis.- Metabolic Pathogenesis.- 8 Myelopathies.- HIV-Related Myelopathies.- Vacuolar Myelopathy.- Gracile Tract Degeneration.- Delayed Myelination of Corticospinal Tracts.- Human Immunodeficiency Virus Myelitis.- Herpes Virus Myelitis.- Cytomegalovirus.- Herpes Simplex Virus.- Varicella Zoster Virus.- 9 Neuropatho’ogy of AIDS in Children.- Clinical Manifestations.- Pathologic Features.- Gross Neuropathologic Findings.- Microscopical Findings.- Miscellaneous Findings.- Review of Reported Cases.- Conclusions.- 10 Peripheral Nerve and Muscle Disease in mv Infection.- Classification.- Seroconversion.- HIV-Seropositive.- Inflammatory Neuropathies.- VII Nerve Palsy.- ARC and AIDS.- Subclinical.- Mononeuritis Multiplex.- Cranial Neuropathies.- Polyradiculopathies.- Distal Symmetrical Peripheral Neuropathies.- Toxic Neuropathy.- Incidental and Isolated Case Reports.- Autonomic Neuropathies.- Tuboreticular Inclusions.- Myopathies.- Polymyositis.- Non-inflammatory Myopathy.- Nemaline Rod Myopathy.- Type II Muscle Fibre Atrophy.- Zidovudine-Induced Myopathy.- 11 Role of the Macrophage in HIV Encephalitis.- Mononuclear Phagocytes of the Nervous System: Macrophages and Microglia.- Changes in the Mononuclear Phagocyte Population of the CNS in HIV Infection and AIDS.- Infection of Mononuclear Phagocytes of the Nervous System in HIV Infection and AIDS.- Evidence for Infection of Other CNS Cell Types by HIV.- Comparison of HIV with Other Lentiviruses: Inflicted Damage to the CNS.- Pathogenesis of CNS Damage by HIV and its Relation to Mononuclear Phagocyte Infection: Possibilities and Remaining Uncertainties.- Summary.- 12 Immunohistochemical and In Situ Hybridization Study of HIV Encephalitis.- Visualization of HIV in the Nervous System.- Electron Microscopy.- Immunocytochemistry.- In Situ Hybridization.- Polymerase Chain Reaction.- Potential Mechanisms of HIV-Associated Neurological Diseases.- Indirect Causes of CNS Damage.- Direct Viral Causes of eNS Damage.- Conclusions.- Unanswered Questions.- 13 Overview of HIV in the Nervous System.- General Considerations Concerning Neurological Involvement.- Pathology and Pathogenesis.- Neuropsychological and Neurophysiological Assessment in HIV Infection.- Paediatric AIDS.- Treatment Considerations.- Animal Models for HIV Infection.