Neuropathology of Human Immunodeficiency Virus 1 Infection

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Abstract
Objective.—In sub-Saharan Africa, only a few studies of neurologic complications of human immunodeficiency virus 1 (HIV-1) infection have been done. The authors studied neuropathology of HIV-1 infection in Tanzania. Design.—Forensic autopsy study at Dar es Salaam, Tanzania. Setting.—A joint research project between Dar es Salaam, Tanzania, and Kumamoto, Japan. Patients.—Thirty patients with risk factors for HIV-1 infection. Main Outcome Measures.—Human immunodeficiency virus 1 infection was evaluated by HIV-1 antibody test on postmortem serum samples. The brains of HIV-1–infected persons were studied histopathologically. Results.—Infection with HIV-1 was identified on postmortem serum samples in 10 of 30 forensic autopsy cases. Neuropathologic changes of the brain were observed in 8 of the 10 HIV-1–infected persons; these changes consisted of lymphocytic meningitis, bacterial meningoencephalitis, cryptococcal meningoencephalitis, tuberculous meningitis with brain abscesses, and intracerebral hemorrhage. Conclusions.—Because none of the persons studied was suspected to have had brain diseases before autopsy, the results suggest that brain diseases of HIV-1–infected patients are likely to go unrecognized in Tanzania. In addition, the high incidence of neuropathologic findings in HIV-1–infected persons indicates that HIV-1–related brain diseases are common in Tanzania, as they are in developed countries. Further forensic autopsy study will determine the range and prevalence of brain complications and have immediate impact on the management of HIV-1–infected patients in Tanzania and other developing countries.