Arteriopathy in Children with Acquired Immune Deficiency Syndrome

Abstract

Pathologic features of the arteries of different organs (heart, lungs, kidneys, spleen, intestine, brain) seen at autopsy in 6 children with acquired immune deficiency syndrome (AIDS) are described. Small and medium-sized arteries, which were the most commonly involved, showed intimal fibrosis with fragmentation of elastic tissue, fibrosis and calcification of media with variable luminal narrowing, and a vasculitis or perivasculitis that was seen only in the brain in association with AIDS encephalopathy. In 1 case aneurysms of the right coronary artery with thrombosis and myocardial infarction were seen. Vascular inflammation, seen only in the brain, may be related to the agent associated with AIDS encephalopathy. The fibrocalcific arterial lesions most closely resemble idiopathic arterial calcification of infancy, but because of differences in age incidence, clinicopathologic and immunologic features, and the size and distribution of the involved arteries, the arterial lesions of pediatric AIDS appear to constitute a distinctive arteriopathy. Infection, secondary to immunodeficiency and resulting in increased exposure to endogenous and exogenous elastases, may be the pathogenesis. Luminal narrowing caused by arterial lesions may play a contributory role in the pathogenesis of the atrophy, cell depletion, scarring, and necrosis or infarction found in organs of children with AIDS. Pediatricians should be alerted to the possibility of arterial involvement in pediatrics AIDS.

Dilated Cardiomyopathy Associated With Simian AIDS in Nonhuman Primates

“…Whether these findings represent a continuum or distinct lesions remains to be determined. Similar coronary vascular findings have been reported in children with AIDS, 25,26 suggesting that the juvenile nature of the rhesus macaques may be germane to the pathogenesis. Pulmonary arteriopathy has been recognized more commonly in both human 27,28 and simian AIDS.…”

Aneurysmal Subarachnoid Hemorrhage in a Patient With Human Immunodeficiency Virus Type 1 Infection-Case Report-

“…Observation of the vascular pathology in the small and medium arteries of various organs, including the brain, in six children at autopsy found intimal fibrosis with fragmentation of elastic tissue, fibrosis, and calcification of media with variable luminal narrowing, and vasculitis or perivasculitis only in the brain in association with AIDS encephalopathy. 5) The vascular changes seen in HIV-infected patients may be due to either a direct toxic effect of a viral antigen on the endothelial cells or subtle membrane changes in the endothelium cells resulting in enhanced interleukin-1 activity with leukocyte adherence. 8) Vasculitis caused by antigenantibody complexes may be involved in the pathogenic changes of the blood vessels in some cases.…”

HIV envelope gp120 activates human arterial smooth muscle cells

“…The arteriopathy involved thickening of the SMC-rich intima, similar to that seen with chronic rejection in cardiac transplant patients. Joshi et al (3) reported a distinct arteriopathy in pediatric AIDS patients involving small and medium-sized arteries, which resulted in coronary luminal narrowing. There have also been increasing reports of acute coronary and arterial thrombotic events in patients with HIV on protease inhibitors (1).…”

“…This has been attributed to the use of protease inhibitors, which have adverse side effects such as hypercholesterolemia, hypertriglyceridemia, and insulin resistance. However, evidence from autopsy studies (2,3) performed in the ''preprotease era'' also demonstrated eccentric atherosclerotic lesions in the proximal coronary arteries and intimal fibrosis, in the absence of traditional cardiac risk factors.…”