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Figure 2 Microscopic anatomy of HIV brain disease. (a) Hematoxylin and eosin-stained, paraffin embedded section of AIDS brain tissue. A large microglial nodule is present in the center of the section (surrounded by three arrows). Numerous elongated microglial nuclei are present both within the nodule and in the surrounding tissue (arrowheads). Original magnification, x 600. (b) HIV p24 immunoperoxidase-stained, paraffin embedded section of AIDS brain tissue. Several large multinucleated giant cells (surrounded by arrows) contain black, amorphous immunoprecipitate of density similar to that of the oval nuclei. Numerous mononuclear macrophages (arrowheads) are distributed throughout the tissue. Original magnification, x 300 (courtesy of Clayton A. Wiley, University of Pittsburgh).

Figure 3 Dendritic pathology in HIV. Golgi-impregnated dendritic segments from control (a) and two cases with HIV dementia. There is loss of dendritic spines (b and c) and distortion and abnormal vacuolation of dendritic segment (c) (courtesy of Drs. Eliezer Masliah, University of California, San Diego, and Clayton A. Wiley, University of Pittsburgh).

Figure 3 Dendritic pathology in HIV. Golgi-impregnated dendritic segments from control (a) and two cases with HIV dementia. There is loss of dendritic spines (b and c) and distortion and abnormal vacuolation of dendritic segment (c) (courtesy of Drs. Eliezer Masliah, University of California, San Diego, and Clayton A. Wiley, University of Pittsburgh).

typically unemployable and may have difficulty with independent living. The symptoms include significant psychomotor slowing and incoordination, marked inattention, slowness in information processing, difficulty in learning new information, and impairment in fluency. In some cases, the dementia may be accompanied by psychosis, including manic and paranoid phenomena. Some patients become markedly agitated, and others become apathetic and sometimes mute. The onset of frank dementia is a poor prognostic sign in HIV disease and is predictive of near future death in many instances.

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