Neuropathology of the acquired immune-deficiency syndrome (AIDS)

Obiettivo

The purpose of the Concerted Action (CA) was to coordinate the pathological study of lesions of the nervous system (NS) in the acquired immune-deficiency syndrome (AIDS). Therefore it had 3 simultaneous objectives:
1 To find an agreement about the nomenclature and classification of the various NS lesions found in AIDS patients especially human immunodeficiency virus (HIV)- related lesions of central NS (CNS) and peripheral NS (PNS); and define the criteria necessary for the morphological diagnosis of these lesions. Simultaneously, it was decided to define a protocol for optimal handling of material allowing both to perform classical neuropathological studies necessary for clinico-pathological correlations and to save material for virological and molecular-biological studies and to appreciate the potential infectivity of post mortem material.
2 To initiate and increase collaboration with virologists and molecular biologists for a better understanding of the interactions of HIV and the NS and of the pathogenesis of NS lesions in AIDS.
3 To define collaboration with clinicians (neurologists, neuroradiologists, immunologists) in order to establish and standardize the modalities of prospective longitudinal clinico-pathological studies and to permit reliable multicentric clinico-pathological studies.
Methodology, ethical considerations and statistic (when necessary) have been considered for each goal.
The purpose of this concerted action (CA) is to coordinate the pathological study of lesions of the nervous system in acquired immune deficiency syndrome (AIDS). The CA has promoted several multicentre and multidisciplinary studies of rare cases for research.
They include:
demonstration of a synergistic action of human immunodeficiency virus (HIV) and deoxyribonucleic acid (DNA) viruses such as cytomegalovirus (CMV), varicella zoster virus (VZV), herpes simplex virus (HSV) or Papovavirus in HIV encephalitis;
neuropathological and virological study of foetuses from HIV infected mothers;
neuropathological and virological study of paediatric cases;
examination of non AIDS, HIV seropositive cases and clinically nonneurologically involved AIDS patients;
morphometric studies of cortical lesions in AIDS;
studies on clinicopathological consequences of treatments;
study of lesions of spinal cord and sensory ganglia in AIDS patients;
study of central nervous system (CNS) lymphomas in AIDS.

The CA has further developed 2 reports on the nomenclature, classification, and neuropathology of HIV infection.
Involvement of the nervous system (NS) is frequent in AIDS. It has been demonstrated that 40-50% of all patients with AIDS have neurological symptoms which in 10% of the cases may be the first manifestation of the disease and which represent a major cause of disability and the principal cause of death in that population. In addition, neuropathological studies have shown that 80-100% of AIDS patient have pathological abnormalities in the NS. Because of their very unusual aspect and multiplicity, the definition and classification of the neurological complications of this new disease, allowing a better diagnosis of the clinical and radiological symptoms, a better understanding of their pathogenetic mechanisms and assessment of any possible treatment, have to be settled on pathological data.
Among these neurological complications, lesions due to a direct infection of the NS by the human immunodeficiency virus (HIV) have been observed with increasing frequency; they represent a frequent and increasing cause of dementia, peripheral neuropathies and death in AIDS patients. The characteristic neuropathological features of HIV-related encephalopathy, myelopathy and peripheral neuropathies are now roughly described. However the definition of lesions, their nomenclature and their diagnostic criteria vary which explains partly the variations of incidence of these lesions in the different series.
The pathogenetic mechanisms involved in the lesions of HIV-related encephalopathy, myelopathy and peripheral neuropathies are not yet understood. Understanding of the interactions of HIV and the NS requires collaborative studies of neuropathologists with virologists and molecular biologists.
Finally the understanding of the neurologic manifestations is insufficiently precise to enable development of clinical diagnostic criteria at this time. Prospective studies with detailed and quantified correlation of stage of disease and clinical radiological symptomatology with type, extent and distribution of cerebral changes are needed.

As a result of objectives 2 and 3 multicentric multidisciplinary studies of rare cases available for research have been promoted:
- Demonstration of a synergistic action of HIV and DNA viruses such as CMV, VZV, HSV or Papovavirus in HIV encephalitis.
- Neuropathological and virological study of foetuses from HIV-infected mothers.
- Neuropathological and virological study of pediatric cases.
- Examination of non-AIDS, HIV-seropositive cases and clinically non neurologically involved AIDS patients.
- Morphometric studies of cortical lesions in AIDS.
- Studies on clinicopathological consequences of treatments.
- Study of lesions of spinal cord and sensory ganglia in AIDS patients.
- Study of CNS lymphomas in AIDS.

Campo scientifico

Programma(i)

FP2-MHR 4C - Research and development coordination programme (EEC) in the field of medical and health research, 1987-1991

Argomento(i)

1.2 - Viro-immunological research (basic research)

Invito a presentare proposte

Data not available

Meccanismo di finanziamento

CON - Coordination of research actions

Coordinatore

Hôpital Henri Mondor

Contributo UE

Nessun dato

Indirizzo

94010 Créteil
Francia

Costo totale