Drug-addicts and especially heroin users are immunocompromized even in the absence of HIV infection. The aim of the present study was to compare the neuropathological alterations present in HIV-seronegative and HIV-seropositive drug-addicts. A total of 60 autopsy cases [32 HIV-seronegative subjects, 21 HIV-seropositive patients without signs of acquired immunodeficiency syndrome (AIDS) and 7 HIV-seropositive patients with signs of AIDS] were investigated macroscopically, histologically and immunohistochemically. HIV-seronegative patients presented more frequently with acute drug intoxication, died at a significantly younger age than HIV-seropositive patients and were found to suffer more frequently from brain alcoholic-related changes. These results indicated that ΗIV-seronegative and HIV-seropositive patients possibly differed in their drug consumption and also in their general conditions of life. Activated microglia and a diffuse astrogliosis in the white matter were detected at a significantly higher frequency and found to be more severe in HIV-seropositive patients than in HIV-seronegative addicts. A lymphocytic meningitis was present in 6 out of 21 HIV-seropositive subjects but only in one of the HIV-seronegative addicts. Perivascular infiltrates, consisting of lymphocytes and macrophages, were detected at similar/frequencies in HIV-seronegative and HIV-seropositive patients. Opportunistic infections were only demonstrated in 2 AIDS cases. In 10 of the HIV-seronegative patients and 3 of the HIV-seropositive patients, CD68 and HAM56-positive multinucleated cells were detected scattered in the subarachnoidal space exclusively over the frontal cortex.

Key words: Drug-addicts, HIV, neuropathology

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