HIV Infection of Human Choroid Plexus: A Possible Mechanism of Viral Entry into the CNS

The present study examines the hypothesis that HIV infection of the choroid plexus (CPx) may be an important site of viral entry into the brain. Formalin-fixed, paraffin-embedded CPx was obtained from 25 patients with AIDS and 13 non AIDS patients and was processed for light microscopy and for immunohistochemical detection of HIV gp41, T and B lymphocytes, monocytes/macrophages and endothelial cells. Eleven of the 13 non AIDS CPx were normal and 2 contained inflammatory foci of undetermined etiology. The stroma contained T lymphocytes in all and monocytes in 22%; B lymphocytes and HIV antigen were absent. Choroid plexus of the AIDS cases contained opportunistic infections or lymphoma in 12 and inflammatory foci alone in 6; 7 were normal. T lymphocytes were present in 70% and monocytes in 50%. In addition to the stromal localization, monocytes also were present in supra-epithelial regions and within or adjacent to the capillary endothelium. HIV-positive cells in the CPx were found in 11 cases (44%) and in the supra-epithelial area in another 2. Their presence correlated with neither infection nor lymphoma of the CPx or brain. They were situated in the stroma, supra-epithelial region and (rarely) capillary endothelium. Immunohistochemistry on serial sections identified the HIV-infected cells as monocytes, including those by capillary endothelium and in supra-epithelial areas. The study demonstrates that the CPx contains HIV-infected monocytes in almost half of the cases. Their apposition to endothelium suggests hematogenous origin. These results support the hypothesis that HIV encephalitis may develop from CPx infection.