Morphologic Findings in Children with Acquired Immune Deficiency Syndrome: Pathogenesis and Clinical Implications

Abstract

The lesions observed in biopsy and autopsy material from children with the acquired immunodeficiency syndrome (AIDS) can be divided into three pathogenetic categories: primary lesions related to infection by human immunodeficiency virus (HIV) (e.g., lymphoreticular system and brain); lesions due to the sequelae of HIV infection (e.g., opportunistic infections, pulmonary lymphoid lesions, etc.); and lesions of undetermined pathogenesis (e.g., renal lesions, cardiomyopathy, etc.). The role of morphologic studies in AIDS in understanding the pathogenesis of the various lesions and their clinical implications are discussed by describing the following examples among others. Study of the thymus enabled us to distinguish AIDS from some congenital immune deficiency syndromes. Thymic injury contributes to immunodeficiency in AIDS. Its apparent irreversibility will have to be considered in the long-term management of children with AIDS when specific effective therapy for HIV becomes available. Demonstration of HIV--like particles in the characteristic giant cells in the brain has been instrumental in the recognition of HIV encephalopathy. Biopsy is helpful in the rapid diagnosis of opportunistic infections (OIs). Autopsy study of OIs has shown involvement of clinically unsuspected organs, such as the adrenals. Characterization of the pulmonary lymphoid lesions led to their inclusion as a diagnostic criterion for AIDS in children. Progression of pulmonary lymphoid lesions to a lymphoproliferative disorder was demonstrated at autopsy. Recognition of lesions such as cardiomyopathy and arteriopathy at autopsy should alert clinicians to suspect these disorders during life.

Efavirenz and ritonavir-boosted lopinavir use exhibited elevated markers of atherosclerosis across age groups in people living with HIV in Ethiopia

“…Cerebral aneurysms (Carvalho Neto et al, 2001;Dubrovsky et al, 1998;Kure et al, 1989;Leeuwis et al, 2007;Shah et al, 1996), stroke (Narayan et al, 2002;Park et al, 1990), and general arteriopathy (Joshi et al, 1990(Joshi et al, , 1987Kabus and Greco, 1991) have also been reported in HIV-infected children and adolescent populations. Due to chronic HIV infection and long-term highly-active antiretroviral therapy (HAART) treatment, particularly in pediatric and young adults, people living with HIV are at a higher risk of early onset cardiovascular disease and other non-AIDS related co-morbidities.…”

Stereotactic Biopsy of Cerebral Lesions in AIDS

“…There have been numerous reports on the diagnosis of cerebral lesions in AIDS with use of various radiographic imaging techniques [14][15][16][17], but since the criteria for identification of lesions are presumptive, there is potential for inaccuracy [18][19][20]. At this point, the only reliable means of an accurate diagnosis is histologic tissue examination.…”

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

“…Viral infection is clearly associated with thymic pathology in HIV-1-infected humans (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), and SCID-hu mice (37)(38)(39)(40), simian immunodeficiency virus-infected nonhuman primates (41)(42)(43), and feline immunodeficiency virus-infected cats (44,45 …”