TITLE:
Histopathological Analysis about Autopsies from HIV/AIDS Patients—About Two Decades of Research Comparing Results before and after Antiretroviral Therapy Advent
AUTHORS:
Aline Domingos Pinto Ruppert, Alexandre de Matos Soeiro, Maria Carolina F. de Almeida, Vera Luiza Capelozzi, Carlos V. Serrano Jr.
KEYWORDS:
AIDS; Acute Respiratory Failure; Pathology
JOURNAL NAME:
World Journal of AIDS,
Vol.3 No.3,
September
5,
2013
ABSTRACT: Objectives:
This study considers 489 autopsies of HIV/AIDS patients who died from acute respiratory failure and describes
the demographic data, etiology, and histological pulmonary findings of HIV
associated diseases, comparing results before and after introduction of
antiretroviral therapy. 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 355 men were studied. The mean age was 37 years old. Bronchopneumonia presented in 43% and Pneumocystis jiroveci pneumonia in 38% of patients. Pulmonary
histopathology showed diffuse alveolar damage in 31% and acute interstitial
pneumonia in 23%. The multivariate analysis showed a significant and positive association
between diffuse alveolar damage with disseminated tuberculosis, cirrhosis and
sepsis; and acute interstitial pneumonia with Pneumocystis jiroveci pneumonia
and cytomegalovirosis. After the introduction of antiretroviral therapy we observed an increase in the prevalence of bacterial
bronchopneumonia, sepsis and cirrhosis; and a decrease in Pneumocystis jiroveci
pneumonia and cytomegalovirosis. Conclusions: Coherent to literature, this
study showed a decrease of respiratory failure mortality associated with some opportunistic infections after
antiretroviral therapy introduction. But an increased prevalence of sepsis,
bronchopneumonia and sepsis was observed too. The most prevalent pulmonary
histopathological pattern was diffuse alveolar damage, which suggested a
positive association with disseminated tuberculosis, sepsis and cirrhosis.