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: Build the expected HIV pathology checklist first.
Before checking the options, it helps to recall what HIV actually does to the CNS. It causes a subacute encephalitis marked by microglial nodules, multinucleated giant cells, and cuffing of blood vessels by inflammatory cells (perivascular infiltration). In the cord, it produces a vacuolar myelopathy that especially affects the posterior columns.

Step 2: Tick off the matching options.
Perivascular infiltration, microglial nodules, and posterior column vacuolar myelopathy all appear directly on this checklist, so options (A), (B), and (C) are genuine features of HIV CNS disease.

Step 3: Ask where temporal lobe disease really belongs.
A strong temporal lobe pattern, often with bleeding and necrosis, is the textbook signature of herpes simplex encephalitis, a completely different virus with a different pattern of brain injury. HIV's damage is more spread out and does not target the temporal lobes in this focal way.

Step 4: Conclude.
Because temporal lobe involvement belongs to HSV encephalitis rather than HIV, it is the one option that is NOT a recognized CNS anomaly of HIV.
\[ \boxed{\text{Temporal lobe involvement}} \]