Limits...
The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in mumbai, India.

Lanjewar DN - Patholog Res Int (2011)

Bottom Line: The HIV epidemic in the Asian subcontinent has a significant impact on India.There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries.Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

View Article: PubMed Central - PubMed

Affiliation: Sir J. J. Hospital and Grant Medical College, Byculla, Mumbai, Maharashtra 400008, India.

ABSTRACT
The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

No MeSH data available.


Related in: MedlinePlus

Microscopy of kidney shows tubercle bacilli in tubular lumen (Ziehl-Neelsen stain ×1000).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3108477&req=5

fig3: Microscopy of kidney shows tubercle bacilli in tubular lumen (Ziehl-Neelsen stain ×1000).

Mentions: Demographic data for 236 patients with AIDS shows that a total of 182 (77%) men and 54 (23%) women were included in the study (Table 1). The majority of the patients (192; 81%) were aged 21–40 years. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%). Other risk factors for HIV transmission were blood transfusion (4 patients; 2%), men having sex with men (3 patients; 1%), and unknown risk factor (3 patients; 1%). Of the 236 HIV-positive patients autopsied 223 (94%) died of AIDS-associated pathologies while death in remaining 13 (6%) cases was due to non-AIDS associated diseases. 150 out of 223 (67%) cases had one, 69 (31%) cases had two, and 4 (2%) cases had three pathologies, thus a total of 300 lesions were identified in 223 cases. Discrepancy between antemortem and postmortem diagnosis was found in 42% cases. The prime causes of death and specific AIDS pathology prevalence in HIV positive patients are shown in Table 2. Tuberculosis was the prime cause of death in 149 (63%) patients. Of the 223 patients with AIDS defining pathology 152 (68%) had tuberculosis. 60% (91 out of 152) patients of tuberculosis had hepatosplenomegaly, 50% (76 out of 152), cervical and/or axillary lymphadenopathy, 43% (65 out of 152) weight loss, 25% (38 out of 152) chronic diarrhea, and 22% (34 out of 152) had recurrent fever. TB was widely disseminated in 143 (94%) patients, while 9 (6%) patients showed isolated miliary tuberculosis of lung. Organs involved in cases with disseminated tuberculosis were, lymph node 131 (59%), spleen 127 (57%) (Figure 1), liver 118 (53%), kidney 87 (39%), brain 29 (13%) (TB meningitis 28 and tuberculoma 1), adrenal 18 (8%), GIT 11 (5%), heart 9 (4%), (Figure 2), thyroid 14 (6%), pancreas 6 (3%), and prostate 2 (1%). The predominant histological pattern of HIV-associated tuberculosis was non-reactive, abundant granular necrosis, ill formed or absent granulomas, scanty or no giant cells, scanty or no epithelioid cells and numerous acid-fast bacilli on a Ziehl-Neelsen stain (Figure 3). No premortem or postmortem cultures for tubercle bacilli were obtained and a diagnosis of tuberculosis was established only on histology alone, hence all these cases are diagnosed as “presumptive tuberculosis.”


The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in mumbai, India.

Lanjewar DN - Patholog Res Int (2011)

Microscopy of kidney shows tubercle bacilli in tubular lumen (Ziehl-Neelsen stain ×1000).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108477&req=5

fig3: Microscopy of kidney shows tubercle bacilli in tubular lumen (Ziehl-Neelsen stain ×1000).
Mentions: Demographic data for 236 patients with AIDS shows that a total of 182 (77%) men and 54 (23%) women were included in the study (Table 1). The majority of the patients (192; 81%) were aged 21–40 years. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%). Other risk factors for HIV transmission were blood transfusion (4 patients; 2%), men having sex with men (3 patients; 1%), and unknown risk factor (3 patients; 1%). Of the 236 HIV-positive patients autopsied 223 (94%) died of AIDS-associated pathologies while death in remaining 13 (6%) cases was due to non-AIDS associated diseases. 150 out of 223 (67%) cases had one, 69 (31%) cases had two, and 4 (2%) cases had three pathologies, thus a total of 300 lesions were identified in 223 cases. Discrepancy between antemortem and postmortem diagnosis was found in 42% cases. The prime causes of death and specific AIDS pathology prevalence in HIV positive patients are shown in Table 2. Tuberculosis was the prime cause of death in 149 (63%) patients. Of the 223 patients with AIDS defining pathology 152 (68%) had tuberculosis. 60% (91 out of 152) patients of tuberculosis had hepatosplenomegaly, 50% (76 out of 152), cervical and/or axillary lymphadenopathy, 43% (65 out of 152) weight loss, 25% (38 out of 152) chronic diarrhea, and 22% (34 out of 152) had recurrent fever. TB was widely disseminated in 143 (94%) patients, while 9 (6%) patients showed isolated miliary tuberculosis of lung. Organs involved in cases with disseminated tuberculosis were, lymph node 131 (59%), spleen 127 (57%) (Figure 1), liver 118 (53%), kidney 87 (39%), brain 29 (13%) (TB meningitis 28 and tuberculoma 1), adrenal 18 (8%), GIT 11 (5%), heart 9 (4%), (Figure 2), thyroid 14 (6%), pancreas 6 (3%), and prostate 2 (1%). The predominant histological pattern of HIV-associated tuberculosis was non-reactive, abundant granular necrosis, ill formed or absent granulomas, scanty or no giant cells, scanty or no epithelioid cells and numerous acid-fast bacilli on a Ziehl-Neelsen stain (Figure 3). No premortem or postmortem cultures for tubercle bacilli were obtained and a diagnosis of tuberculosis was established only on histology alone, hence all these cases are diagnosed as “presumptive tuberculosis.”

Bottom Line: The HIV epidemic in the Asian subcontinent has a significant impact on India.There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries.Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

View Article: PubMed Central - PubMed

Affiliation: Sir J. J. Hospital and Grant Medical College, Byculla, Mumbai, Maharashtra 400008, India.

ABSTRACT
The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

No MeSH data available.


Related in: MedlinePlus