Acquired Immune Deficiency Syndrome: Postmortem Findings

La, Guarda; Ma, Lixiang; Jl, Smith; Pw, Mansell; Györkey, Ferenc; An, Roca

doi:10.1093/ajcp/81.5.549

Cited by 197 publications

(30 citation statements)

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“…Fourteen of these patients had chronic renal failure and FSGS was seen in only 43% (6) of these patients on renal biopsy [13]. Similarly some autopsy studies have also found HIVAN as an uncommon lesion on examination of renal tissue [14][15][16][17][18][19][20]. Lower proportion of AfricanAmericans in many of these studies could have accounted for low prevalence of HIVAN.…”

Section: Discussionmentioning

confidence: 99%

Is the Prevalence of HIV-Associated Nephropathy Decreasing?

et al. 1999

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Initial reports have suggested that approximately 10% of patients with HIV-infection develop HIV-associated nephropathy (HIVAN). It has also been predicted that by the end of the decade, HIVAN is likely to become a third leading cause of end-stage renal disease (ESRD) in African-Americans between the ages of 20–64 years. As the morbidity and mortality from HIV-infection has decreased in the last few years, it is possible that prevalence of HIVAN is also changing. We therefore screened HIV-1-infected patients followed in our hospital for HIVAN. A screening urinalysis was performed in 557 HIV-1-infected adult patients between March and May 1998. Of these, 252 were outpatients and 305 were Texas Department of Criminal Justice inmates (TDCJI). Demographic and laboratory data of these patients was obtained from the HIV patients’ database. Fifty percent of the patients were African-American, 36.6% were Caucasian and 12.7% were Hispanic. The mean age of patients was 37 ± 8 years. Seventy-nine percent of the patients were males and a history of intravenous drug abuse (IVDA) was present in 28%. Twenty-three percent of the patients were concomitantly infected with hepatitis C virus, 4.1% were positive for hepatitis B surface antigen, and rapid plasma reagin test for syphilis was positive in 9.1%. In 38 patients who had more than 100 mg/dl (2+) proteins on screening urinalysis, total urinary proteins were quantitated by collecting 24 h urine specimens. Fifteen of these patients had urinary proteins more than 1.5 g/day (12 patients >3.5 g/24 h and 3 patients >1.5 g/24 h). A renal biopsy was done in 14 of these patients and clinical diagnosis of HIVAN was made in one patient who refused biopsy. Renal biopsies revealed HIVAN [9], diabetic nephropathy [2], membranoproliferative glomerulonephritis [2], Fibrillary glomerulonephritis [1]. All 10 patients (5 TDCJI and 5 outpatients) with HIVAN were African-American. Two of these 10 patients had a history of IVDA and another two were concomitantly infected with hepatitis C virus. The plasma viral load (Pvl) and total CD4 count was not different in patients with or without HIVAN [(Pvl log 10.05 ± 1.39 vs. 9.9 ± 2.18 copies/ml, p = 0.78) (CD4: 187 ± 192 vs. 288 ± 249 cells/μl, p = 1.17) mean ± SD]. We conclude that in our HIV-infected population HIVAN exclusively affected African-Americans and the prevalence in them was 3.5%.

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Section: Discussionmentioning

confidence: 99%

Is the Prevalence of HIV-Associated Nephropathy Decreasing?

et al. 1999

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“…Following these, the next most frequent tumors were lymphoid neoplasias and KS (2.7% and 2.3%, respectively). There are studies showing greater prevalence of lymphoid tumors 7,12,20,27 and others presenting greater frequency of KS 1,19,24,28 among HIV-positive patients. In our study, these frequencies were similar, as shown by other authors 23,32 .…”

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confidence: 99%

Benign and malignant neoplasias in 261 necropsies for HIV-positive patients in the period of 1989 to 2008

Micheletti

Macedo²,

Silva³

et al. 2011

Rev. Inst. Med. trop. S. Paulo

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Considering that there are some studies with autopsies from AIDS describing only malignant neoplasias and that changes can occur after the introduction of Highly Active Antiretroviral Therapy (HAART), our objectives were to analyze the frequency of benign and malignant neoplasms in AIDS patients in the periods of both pre- and post-HAART. This is a retrospective study with 261 autopsies of HIV-positive patients between 1989 and 2008 in Uberaba, Brazil. Sixty-six neoplasms were found (39 benign, 21 malignant and six premalignant) in 58 patients. The most frequent malignant neoplasms were lymphoid, in 2.7% (four Non-Hodgkin lymphoma, one Hodgkin, one multiple myeloma and one plasmablastic plasmacytoma), and Kaposi's Sarcoma, in 2.3% (six cases). The most frequent benign neoplasms were hepatic hemangiomas in 11 (4.2%) of 261 cases and uterine leiomyoma in 11 (15.7%) of 70 woman. In the pre-HAART period eight (9.8%) benign neoplasias and four (4.9%) malignant occurred in 82 patients; in the post-HAART period, 29 (16.2%) benign and 17 (9.5%) malignant were present; however, the differences were not significant. We conclude that the introduction of HAART in our region doesn't look to have modified the frequency of neoplasms occurring in patients with HIV.

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“…Other investigators have associated cerebral infarcts in HIV-infected patients with hepatitis B 42 (hepatitis B or C serology was positive in 6 of our patients), as well as with a prothrombotic state related to protein S deficiency, 35,36 antiphospholipid antibodies, 39,40 or disseminated intravascular coagulopathy. 4,11,12 We have protein S levels, which were normal, for only 1 patient, and none of our patients had antiphospholipid antibodies measured. Thus, the theoretical possibility of "hypercoagulability" remains, although intravascular thrombi, recent or organized, were seen only rarely in this and other autopsy series, even in those cases with very recent infarcts.…”

Section: Discussionmentioning

confidence: 66%

Cerebral Infarction in Adult AIDS Patients

Connor

Lammie

Bell

et al. 2000

Stroke

158

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Background and Purpose-Autopsy series of patients with AIDS have found a 4% to 29% prevalence of cerebral infarction. Little is known of the prevalence of cerebral infarction when not associated with non-HIV central nervous system (CNS) infection, lymphoma, or cardioembolic sources. Clinical correlation has seldom been available. We describe the pathological and clinical features of patients from the Edinburgh HIV Cohort Study found to have had cerebral infarcts without evidence of non-HIV CNS infection, CNS lymphoma, or cardioembolic sources at autopsy. Methods-From 183 autopsy cases, 26 without evidence of opportunistic cerebral infection or lymphoma were selected.These 26 cases went through a second selection process in which the presence of cerebral infarction, in the absence of the conditions mentioned, was verified. Histology and clinical records for the remaining patients were reviewed. Results-Ten (5.5%) cases fulfilled the inclusion criteria and demonstrated similar hypoxic-ischemic lesions. Small-vessel thickening was seen in all cases, and perivascular space dilatation, rarefaction, and pigment deposition, with vessel wall mineralization and perivascular inflammatory cell infiltrates, were seen in some cases. Vasculitis was not found. One patient had had a transient ischemic attack, and no patient had had a stroke. Conclusions-Cerebral infarcts in HIV-infected patients are not common in the absence of cerebral non-HIV infection, lymphoma, or embolic sources. We found an HIV-associated vasculopathy with similar features in all risk groups. In AIDS patients presenting with stroke or transient ischemic attack, potentially treatable causes, such as cerebral coinfection or tumor, should be sought.

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Acquired Immune Deficiency Syndrome: Postmortem Findings

Cited by 197 publications

References 0 publications

Is the Prevalence of HIV-Associated Nephropathy Decreasing?

Is the Prevalence of HIV-Associated Nephropathy Decreasing?

Benign and malignant neoplasias in 261 necropsies for HIV-positive patients in the period of 1989 to 2008

Cerebral Infarction in Adult AIDS Patients

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