Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study

Abstract

SUMMARYInvolvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5%) cases. The most common infections were candidiasis (42%), cytomegalovirus (29%), histoplasmosis (11.8%), toxoplasmosis (9.7%) and mycobacterial infection (9.7%). Malignancies were rare, present in four (4.3%) cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma). All segments showed lesions: tongue (48.6%), esophagus (44.8%), stomach (44.7%), colon (43.2%) and small intestine (28.9%). The lesions found were immediate cause of death in five (5.4%) cases. In another 36 (38.7%) cases the basic disease was systemic and also compromised the digestive system.

Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy)

“…These findings are in agreement with other necropsy studies that showed changes in the digestive system in 82.3% of 45 necropsies and 61.2% of 49 necropsies 3 , 4 . Our previous necropsy study performed in the pre-HAART phase showed changes in the digestive system in 78.5% of cases 17 . The higher prevalence of infection by Candida sp 17 …”

“…Although only 90 of the 322 cases were diagnosed prior to 1997 (and were part of a previously published study 17 ), most patients (185 cases; 57.4%) in this study had no antiretroviral therapy, filling the criteria of group A; 83 (25.8%) were enrolled in group B; and only 54 (16.8%) cases were included in group C. Table 1 shows the distribution of the 322 cases by age and sex according to the study group.…”

Cytomegalovirus Infection of the Gastrointestinal Tract in Soweto, South Africa: A Look Back at the Clinical and Histological Features over 8 Years

“…There are few studies especially from Sub Saharan Africa on CMV infection of the GIT due to difficulties in confirming the diagnosis. An autopsy study found CMV infection of the GIT in 29% of cases [12], this may indicate underdiagnosis. The GIT sites more frequently diagnosed with CMV in our study were oesophagus and colon similar to other studies [13,14].…”

HIV-Associated Gastrointestinal Cancer

“…Despite the large variety of diseases of the esophagus, including virus-associated malignancies [5], data on primary carcinoma in HIV-positive patients are rare. Tobacco use, 1 of the accepted risk factors for squamous cell carcinoma, is much more prevalent in the HIV-infected compared to the HIV-negative population [11].…”

“…The gastrointestinal tract (GIT) plays a significant role in this context. An autopsy study in AIDS patients showed diseases of the GIT in 79% [5]. The degree of immunosuppression has a profound negative influence on incidence and outcome of carcinoma, irrespective of whether the tumor is infection associated or not [4,6].…”