Principais alterações morfológicas no sistema nervoso central em necrópsias de pacientes HIV positivos realizadas no Hospital Escola da Universidade Federal do Triângulo Mineiro, no periódo de 1989 a 1996.

Abstract

This is a retrospective study of 92 autopsy case of HIV patients, from a total of 847, realized from January, 1989 through December, 1996, in the Universidade Federal do Triângulo Mineiro, Uberaba MG. The objective was to valuated the lesions in the central nervous system (CNS) before the introduction of HAART (highly active antiretroviral therapy). The median age was 34 ± 11 years old and 18,5% was female. All of cases presented some lesion in the CNS, although, in only 54 (58,25%) it seems important to death. Only 15 (27,8%) from 54 cases, had a clinician diagnosis of the lesion founded at the autopsy. The most frequent lesion was neurotoxoplasmosis (31 cases; 33,7%), followed by cryptococosis (11 cases; 11,9%), cytomegalovirosis (4 cases; 4,3%), microglial nodular encephalitis (3 casos, 3,3%), bacterial meningitis (2 cases; 2,2%), JC virus (2 cases; 2,2%), tuberculosis/atypical mycobacteriosis (2 cases; 2,2%), hystoplasmosis (1 case; 1,1%) and paracoccidioidomicosis (1 case; 1,1%). There were 3 (3,3%) cases from 54 cases with two concomitants infections (toxoplasmosis + bacterial meningitis; toxoplasmosis + cytomegalovirosis; paracoccidioidomicosis + cytomegalovirosis). In the others 38 (41,3%) cases there were one case of old infarct and another case with several calcified-necrotics areas from old toxoplasmosis lesion. In the rest of then, the lesions did not seem important (gliosis, calcifications, meninge fibrosis) or it was edema associated to septicemy and/or anoxic state. Morphologic alterations related to HIV and neoplasma were not diagnosed. This study shows that CNS in HIV patients has several lesions, mainly opportunistic infections in our region, lot of them without clinical diagnosis. These findings suggest that a carefully investigation should be done in the CNS of HIV patients, particularly in those who are not responding to therapy.