Neuropathology of HIV infection in haemophiliacs: comparative necropsy study.

Abstract

OBJECTIVE--To discover whether pathological and neuropathological findings at necropsy are different in haemophiliacs and other subjects positive for HIV. DESIGN--Pathological and neuropathological findings at necropsy were compared in haemophiliacs and non-haemophiliacs, most of them homosexual men. SETTING--Necropsies performed in the south of England. SUBJECTS--11 Haemophiliacs (mean age 41, range 15-69) and 31 non-haemophiliacs, 29 of whom were homosexual men (mean age 40, range 21-60). AIDS was diagnosed before death in four haemophiliacs and all but one of the non-haemophiliacs. MAIN OUTCOME MEASURES--Prevalence of various forms of neuropathology and systemic pathology in the haemophiliacs and non-haemophiliacs, compared with Fisher's exact test. RESULTS--The prevalences of opportunistic infections of the central nervous system were significantly higher in the non-haemophiliacs (cerebral toxoplasmosis 23% (7), progressive multifocal leucoencephalopathy 10% (3), and cerebral cytomegalovirus infection 19% (6) in the non-haemophiliacs v no cases in the haemophiliacs). The prevalences of fresh and old intracranial haemorrhages and cirrhosis of the liver were significantly higher in the haemophiliacs (fresh intracranial haemorrhage 45% (5), old intracranial haemorrhage 36% (4), and cirrhosis of the liver 27% (3) in the haemophiliacs v no cases in the non-haemophiliacs). The prevalence of neuropathological changes in the non-haemophiliacs was similar to that found in other necropsy series. CONCLUSIONS--The main causes of death in haemophiliacs positive for HIV included intracranial haemorrhage and cirrhosis of the liver. The haemophiliacs died when the characteristic neuropathological changes associated with HIV infection were at a fairly early stage in their development.