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An update on the neuropathology of HIV in the HAART era
Author(s) -
Bell J E
Publication year - 2004
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/j.1365-2559.2004.02004.x
Subject(s) - neuropathology , context (archaeology) , medicine , dementia , immunology , immune system , central nervous system , microglia , human immunodeficiency virus (hiv) , immunopathology , disease , biology , pathology , inflammation , paleontology
This review compares the neuropathology of highly active antiretroviral therapy (HAART)‐treated HIV+ individuals with the reported central nervous system (CNS) findings from the pre‐HAART era. HAART has had considerable success in combating HIV‐related immune collapse and has prevented many of the former end‐stage complications of AIDS. However, with increased survival times the prevalence of minor HIV‐associated cognitive impairment appears to be rising among treated patients and this may be a particular risk for older individuals. HIV encephalitis (HIVE) is still prevalent in treated patients although attenuated forms of HIVE and CNS opportunistic disorders are also observed. Some subjects show very significant CNS lymphocytic infiltrates in the context of HAART‐induced immune reconstitution. HIV‐associated cognitive impairment correlates best with the increased presence of activated, though not necessarily infected, microglia and CNS macrophages. This suggests that indirect mechanisms of neuronal injury and loss occur in HIV/AIDS as a basis for dementia since neurones are not themselves productively infected. Research to elucidate the mechanisms of neuronal injury in HIV/AIDS may contribute to the understanding of CNS function not only in HAART‐treated subjects but also in other neurodegenerative disorders.