Which of the following is not seen HIV involvement of CNS -
Human Immunodeficiency Virus in the first 15 years or so after recognition of AIDS, neuropathologic changes were demonstrated at postmoem examination in as many as 80% to 90% of cases, owing to direct effects of virus on the nervous system, oppounistic infections, and primary CNS lymphoma. Introduction of highly active antiretroviral therapy (HAA) has decreased the frequency of these secondary effects of HIV infection. However, cognitive dysfunction ranging from mild to fullblown dementia that is lumped under the umbrella term HIV-associated neurocognitive disorder (HAND) continues to be a source of morbidity. The cognitive symptoms are believed to stem from HIV infection of microglial cells in the brain. This leads to activation of innate immune responses, both in infected microglial cells and unaffected bystanders. The ensuing neuronal injury likely stems from a combination of cytokine-induced inflammation and toxic effects of HIV-derived proteins. Aseptic meningitis occurs within 1 to 2 weeks of onset of primary infection by HIV in about 10% of patients; antibodies to HIV can be demonstrated, and the virus can be isolated from the CSF. The few neuropathologic studies of the early and acute phases of symptomatic or asymptomatic HIV invasion of the nervous system have shown mild lymphocytic meningitis, perivascular inflammation, and some myelin loss in the hemispheres. After the acute phase, an HIV encephalitis (HIVE) commonly can be found if affected persons come to autopsy.HIV encephalitis is best characterized microscopically as a chronic inflammatory reaction with widely distributed infiltrates of microglial nodules, sometimes with associated foci of tissue necrosis and reactive gliosis. The microglial nodules also are found in the vicinity of small blood vessels, which show abnormally prominent endothelial cells and perivascular foamy or pigment-laden macrophages. These changes occur especially in the subcoical white matter, diencephalon, and brain stem. An impoant component of the microglial nodule is the macrophage-derived multinucleate giant cell. In some cases, there is also a disorder of white matter characterized by multifocal or diffuse areas of myelin pallor with associated axonal swellings and gliosis. HIV is present in CD4+ mononuclear and multinucleate macrophages and microglia. Ref: Robbins Basic Pathology 9th edition pg no 828
Perivascular giant cell
Vacuolar degeneration of post column
Microglial nodule formation
Inclusion bodies
Nervous system