Leila Chimelli; Sérgio Rosemberg
RESUMO
O sistema nervoso é freqüentemente comprometido em pacientes com a síndrome de imunodeficiência adquirida. As lesões observadas podem decorrer da ação direta do vírus da imunodeficiência humana (HIV), de agentes oportunistas, do aparecimento de neoplasias e de eventuais fatores inespecíficos como alterações circulatórias, metabólicas ou degenerativas. Dentre as alterações diretamente relacionadas à ação do HIV estão a encefalite e a leucoencefalopatia do HIV, a poliodistrofia difusa e a mielopatia vacuolar. A patogenia destas lesões ainda não está plenamente elucidada, sendo que os macrófagos são as principais células infectadas pelo HIV, parecendo que os efeitos citotóxicos sobre as células do sistema nervoso sejam indiretos, talvez a partir de substâncias liberadas pelos macrófagos infectados. Dentre as infecções oportunistas, a mais freqüente é a toxoplasmose, seguida da criptococose e da infecção pelo citomegalovírus, com algumas diferenças nas séries dos vários países. Vários outros agentes já foram observados no sistema nervoso de pacientes com AIDS. Dentre as neoplasias, o linfoma primário de células B é o mais freqüentemente encontrado. E comum o achado de mais de uma infecção ou a associação de infecções e neoplasia no sistema nervoso de pacientes com AIDS.
Palavras-chave: AIDS. HIV. Neuropatologia
ABSTRACT
The nervous system is frequently involved in patienls with AIDS. The lesions can be due to lhe human immunodeficiency virus (HIV), to opportunistic agents, to the development of tumours, and to occasional nonspecific factors, such as circulatory, metabolic and degenerative changes. The changes directly related to the presence of the HIV include the HIV encephalitis and leucoencephalopathy, the diffuse poliodystrophy and the vacuolar myelopathy. The pathogenesis of these lesions is not yet completeby clear. Macrophages are the main cells infected by the HIV, and it seems that the cytotoxic effects on the nervous tissue are indirect, may be due to the release of substances by infected macrophages. Among the opportunistic infections, the most frequent is toxoplasmnosis followed by cryptococcosis and cytomegalovirus infection, with some differences in series from various countries. Many other agents have been observed in the brain of patients with AIDS. B cell tymphoma is the the most frequent tumour found in the brain and it is not uncommon the association of infections and/or tumours.
Keywords: AIDS. HIV. Neuropathology.
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Endereço para correspondência:
Dra. Leila Chimelli.
Depto. de Patologia/FMRP/USP.
14049-900
Ribeirão Preto, SP.
Recebido para publicação em 05/03/93.
Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP e Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP.
