AEGiS-11IAC: Clinical and autopsy diagnoses of central nervous system (CNS) opportunistic diseases in 528 patients with AIDS.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Clinical and autopsy diagnoses of central nervous system (CNS) opportunistic diseases in 528 patients with AIDS.

Int Conf AIDS 1996 Jul 7-12; 11:222 (abstract no. Th.B.182)
d'Arminio-Monforte A, Vago L, Nebuloni M, Formenti T, Sala E, Gervasoni C, Costanzi G, Moroni M; Pathology Department, L. Sacco Hospital, University of Milan, Italy. Fax: +39-2-3560805.

OBJECTIVE: to evaluate the frequency of the clinical and autopsy diagnoses of opportunistic diseases of cns (c-od) in a consecutive series of AIDS patients (pts) with autopsy examination; to establish the rate of concordant and discordant diagnoses for each disease.

METHODS: 528 AIDS pts diagnosed and died at our Department with consecutive autopsy examination from 1985 to June 1995. Till 1993 the clinical diagnosis of c-od was done following CDC guidelines. From 1994 the positivity for the genomes of JCV, EBV, CMV, HSV -I and-II by PCR on cerebrospinal fluid (CSF) together with clinical and neuroradiological suggestive findings were considered as presumptive diagnosis of PML, primary cerebral lymphoma-PCL-, CMV encephalitis (CMV -e) and HSV encephalitis (HSV -e) respectively.

RESULTS: The 528 pts represent the 53% of the pts died and the 87% of those died during hospitalization in the same period. 174 pts (33%) had a diagnosis of c-od in life (14 with two c-od): TE (n=97; 18%), cryptococcosis (crypto-) (n=30; 6%), PML (n=27; 5%), PCL (n=19; 4%), CMV-e (n=11; 2%), and tuberculous meningitis (tb-men) (n=3; 0,5%), HSV-1-e (n=1). At autopsy 296 c-od were identified in 257 pts (49%) (39 pts with more than 1): CMV-e (n=79; 15%), TE (n=69; 13%), malacic lesions suggestive for TE (n=24; 5%), PCL (n=44; 8%), PML (n=39; 7%), crypto- (n=24; 5%), tb-men (n=7; 1%), HSV-e (n=5; 1%), MAC-encephalitis (n=3; 0,5%) and mycoses (n=2; 0,3%). A total of 348 c-od were diagnosed either in life and/or at autopsy: 52 (15%) only in life, 161 (46%) only at autopsy and 135 (39%) in both cases. TE was the disease with a higher rate of clinical diagnosis only (37/130 cases). CMV-e accounted for 82 cases, 71/82 diagnosed only at autopsy. PCL was diagnosed in 45 cases, 58% only at autopsy. PML was diagnosed in 40 cases, (65% of concordant diagnoses), crypto- in 33 cases (64% of concordant diagnoses and 9 cases -27%-of clinical diagnosis only). Only 1/5 cases of HSV-e was recognized in life. All HSV-e were concomitant with CMV-e.

CONCLUSION: this study confirms the high frequency of c-od unrecognized in life. In particular, CMV-e is found in 15% of autopsies, and is rarely diagnosed in life without PCR. On the contrary, about one third of TE and cryptodiagnosed in life were not found at autopsy.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Leukoencephalopathy, Progressive Multifocal, Cytomegalovirus, Central Nervous System, Encephalitis, Cytomegalovirus Infections, Polymerase Chain Reaction, Simplexvirus, Herpesvirus 4, Human, Autopsy, Central Nervous System Diseases, Herpesvirus 1, Human, Human, Male, cerebrospinal fluid, ICA11

960707
ThB182