Chapter 28 – Neuropathology of AIDS

This chapter reviews the range of neuropathologic abnormalities found in adults and children with acquired immunodeficiency syndrome (AIDS). The spectrum of neurologic disorders includes HIV-1-associated dementia (HAD) and related cognitive and motor disorders, vacuolar myelopathy, and peripheral neuromuscular disorders. The etiologic basis of these clinical syndromes is principally attributable to the direct and indirect effects of HIV-1 on the nervous system, to opportunistic infections, or neoplasms. It is well known that multiple etiologic agents may cause neurologic disease in any affected individual. The incidence of these disorders has declined remarkably since the introduction of highly active antiretroviral therapy (HAART). However, neurologic disability continues to be an important complication of AIDS, as most current antiretroviral drugs have relatively poor central nervous system (CNS) penetration and the CNS is a reservoir for long-term viral persistence. In response to this challenge, through intensive research over the past decade, the mechanisms of injury of the nervous system are slowly beginning to be understood.