Question

Which of the following is NOT a CNS anomaly seen in HIV infection?

• A. Perivascular infiltration
• B. Microglial nodules
• C. Vascular myelopathy of the posterior column
• D. Temporal lobe involvement

Hint:

Temporal lobe involvement is classic for HSV encephalitis, not HIV, which instead shows perivascular infiltration, microglial nodules, and vacuolar myelopathy.

Answer 1

The Correct Option is D

Step 1: Recall the typical CNS pathology of HIV.
HIV can directly infect the brain and cause HIV encephalitis (part of HIV-associated neurocognitive disorder). The classic pathological findings include perivascular cuffing by inflammatory cells and multinucleated giant cells, microglial nodules scattered through the white matter, and, in the spinal cord, a vacuolar myelopathy that affects the posterior and lateral columns, resembling the changes seen in vitamin B12 deficiency.

Step 2: Match options (A), (B), and (C) to this picture.
Perivascular infiltration and microglial nodules are the hallmark microscopic findings of HIV encephalitis. Vacuolar myelopathy involving the posterior columns is a well recognized spinal cord complication of HIV. So all three of these are accepted CNS findings in HIV.

Step 3: Explain why temporal lobe involvement does not fit.
Prominent temporal lobe involvement, especially with hemorrhagic necrosis, is the classic finding in herpes simplex virus (HSV) encephalitis, not HIV. HIV encephalitis tends to be more diffuse, involving white matter and subcortical structures, rather than focusing on the temporal lobes.

Step 4: Final conclusion.
Since temporal lobe involvement is not a typical feature of HIV CNS disease, it is the correct answer to "which is NOT seen in HIV".
\[ \boxed{\text{Temporal lobe involvement}} \]