Autopsy evidence confirms that ARVs tackle CNS lesions

Neuropathological data from a large autopsy series have confirmed clinical observations concerning the efficacy of HAART in reducing the frequency of HIV-related CNS lesions in AIDS patients.

Researchers in Milan and other Italian centres reviewed 1,597 consecutive autopsies of HIV-positive patients performed between 1984 and 2000. Their objective was to evaluate the prevalence of HIV-related central nervous system (CNS) lesions (HIV-encephalitis and/or HIV-leukoencephalopathy: HIV-E/L) with and without concomitant opportunistic diseases and to correlate it with the changes in antiretroviral treatment that have occurred since the beginning of the epidemic.

They divided the autopsies into four time periods on the basis of the therapeutic regimens available: 1984–1987, no therapy; 1988–1994, monotherapy (AZT, zidovudine); 1995–1996, dual combination therapy with nucleoside reverse transcriptase inhibitors (NRTI); and 1997–2000, triple combination therapy including two NRTI and at least one protease inhibitor or non-NRTI.

They found that the CNS of 1,210 patients (76%) was affected by opportunistic diseases, HIV-related lesions or both. The prevalence of HIV-related lesions in the four periods was respectively 54%, 32%, 18% and 15%; this reduction was statistically significant (P < 0.000001). During the last period, however, differences in HIV-E/L between treated and untreated patients were not statistically significant, although there were fewer than expected cases among the treated patients (six instead of eight) and more than expected among the untreated patients (10 instead of eight).

The researchers write: “It must be emphasised, however, that even though lower than that reported in other studies, the frequency of HIV-related lesions is still relatively high in patients on antiretroviral treatments (15%). “In conclusion, our data – obtained from a large autopsy series – support the efficacy of antiretroviral treatment in reducing the frequency of HIV-related CNS lesions in AIDS patients.”

Vago, Luca; Bonetto, Sara; Nebuloni, Manuela et al. Pathological findings in the central nervous system of AIDS patients on assumed antiretroviral therapeutic regimens: retrospective study of 1597 autopsies. AIDS 2002 Sep 27;16(14):1925-1928