Post-Mortem Histological Pulmonary Analysis in Patients with HIV/AIDS

Abstract

Soeiro AM, Hovnanian ALD, Parra ER, Canzian M, Capelozzi VL. Post-mortem histological pulmonary analysis in patients with HIV/AIDS. Clinics. 2008;63:497-502. OBJECTIVES:Certain aspects of pulmonary pathology observed in autopsies of HIV/AIDS patients are still unknown. This study considers 250 autopsies of HIV/AIDS patients who died of acute respiratory failure and describes the demographic data, etiology, and histological pulmonary findings of the various pathologies. METHODS:The following data were obtained: age, sex, and major associated diseases (found at the autopsy). Pulmonary histopathology was categorized as: diffuse alveolar damage; pulmonary edema; alveolar hemorrhage; and acute interstitial pneumonia. Odds ratio of the HIV/AIDS-associated diseases developing a specific histopathological pattern was determined by logistic regression. RESULTS: A total of 197 men and 53 women were studied. The mean age was 36 years. Bacterial bronchopneumonia was present in 36% (91 cases) and Pneumocystis jiroveci pneumonia in 27% (68) of patients. Pulmonary histopathology showed acute interstitial pneumonia in 40% (99), diffuse alveolar damage in 36% (89), pulmonary edema in 13% (33), and alveolar hemorrhage in 12% (29) of patients. Multivariate analysis showed a significant and positive association between Pneumocystis jiroveci pneumonia and acute interstitial pneumonia (Odds ratio, 4.51; 95% CI, 2.46 -8.24; p < 0.001), severe sepsis and/or septic shock and diffuse alveolar damage (Odds ratio, 3.60; 95% CI, 1.78 -7.27; p < 0.001), and cytomegalovirus and acute interstitial pneumonia (Odds ratio, 2.22; 95% CI, 1.01 -4.93; p = 0.05). CONCLUSIONS: This report is the first autopsy study to include demographic data, etiologic diagnosis, and respective histopathological findings in patients with HIV/AIDS and acute respiratory failure. Further studies are necessary to elucidate the complete pulmonary physiopathological mechanism involved with each HIV/AIDS-associated disease.

Pneumocystis jirovecii Pneumonia and Alveolar Hemorrhage in a Pregnant Woman with Human T Cell Lymphotropic Virus Type-1 Infection

“…There are various causes of diffuse alveolar hemorrhage (8), but previously the reports suggesting an association of PCP and alveolar hemorrhage were scarce (9). A recent study on autopsy findings of HIV/AIDS patients showed that PCP was often associated with diffuse alveolar hemorrhage (10). In this case, in addition to PCP, the surgery might have influenced the development of alveolar hemorrhage.…”

Pathology of HIV/AIDS: Lessons from Autopsy Series

“…Opportunistic infections were the most common autopsy findings, followed by less frequent secondary neoplasms. Mycobacterial infections were detected in all the series with the lowest frequency around 20% (Afessa et al, 1998;Guerra et al, 2001;Soeiro et al, 2008). In developed countries such as Italy, Germany and Japan, the prevalence of tuberculosis in autopsies of patients with HIV/AIDS is 5-7%, whereas these rates were found to be 38-59% mostly in developing countries (Ansari et al, 2002;d'Arminio Monforte et al, 1992;Hsiao et al, 1997;Kaiser et al, 2000;Lucas et al, 1993;Ohtomo et al, 2000).…”

“…In developed countries such as Italy, Germany and Japan, the prevalence of tuberculosis in autopsies of patients with HIV/AIDS is 5-7%, whereas these rates were found to be 38-59% mostly in developing countries (Ansari et al, 2002;d'Arminio Monforte et al, 1992;Hsiao et al, 1997;Kaiser et al, 2000;Lucas et al, 1993;Ohtomo et al, 2000). Pulmonary lesions tend to hematogenous spread, thus the disseminated variant was described in 60-90% cases (Ansari et al, 2002;Cury et al, 2003;Parkhomenko et al, 2003;Rana et al, 2000;Soeiro et al, 2008). Extremely high rates of tuberculosis were reported in recent studies from Russia and India, 82% and 68%, respectively (Berdnikov et al, 2011;Lanjewar, 2011).…”

AIDS and Opportunistic Infections

“…Afessa et al (Afessa et al, 1998) found bacterial pneumonia to be the most frequent pulmonary complication (42%) in an autopsy series of 233 HIV-infected individuals. In a recent autopsy study, in which 250 autopsies of HIV/AIDS patients who died of acute respiratory failure was analyzed, bacterial bronchopneumonia was present in 36% (91 cases) (Soeiro et al, 2008). According to another study, the incidence of pneumococcal pneumonia is five to 18 times greater than that in the general population, and the development of pneumococcal septicemia is 100 times greater (Janoff et al, 1992).…”