HIV-infected patients may develop a myelopathy without the neuropsychological signs and symptoms of HIVE, labeled HIV-associated myelopathy (HIVM). The histopathological hallmark are vacuoles, most prominent in the cervical and thoracic parts of the spinal cord, and lipid-laden macrophages, hence the term "vacuolar myelopathy" (Petito 1985). These changes are reminiscent of severe combined degeneration and may occur in HIV-negative patients. As HIV viral products have only inconsistently been shown to be part of the lesions, the role of the virus in the disease process is uncertain. Pathogenetically, a disturbance of cobalamin-dependent trans-methylation has been discussed. Like HIVE, HIVM occurs mainly with advanced immunosuppression. Only a proportion of patients with the autoptic finding of vacuolar myelopathy show clinically apparent myelopathy during life (dal Pan 1994).
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