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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 shows spindle cells and slit like vascular channels containing erythrocytes (H & E ×400).
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fig7: Microscopy shows spindle cells and slit like vascular channels containing erythrocytes (H & E ×400).

Mentions: PCJ was identified in 11 (5%) patients. In only one case PCJ was cause of death, while in another 10 cases PCJ was identified in association with tuberculosis, cryptococcosis, and CMV infection. Extra pulmonary PCJ was not present in any patients. Cytomegalovirus infection was identified in 35 (16%) patients. Infection by CMV showed minor lesions, and it was contributory cause of death in these patients. CMV infection was identified in GIT (15), adrenal (8), lung (7), thyroid (4), pancreas (2), kidney (1), heart (1), and brain (1) (Figure 6). Cryptosporidial enteritis was identified in 6 (3%) cases; and it was contributory cause of death in these patients. None of the patients showed hepatobiliary cryptosporidiosis. Candidiasis was noted in 6 cases (esophagus 5 cases and stomach 1 case). 2/236 cases had Kaposi's sarcoma (1%)) (Figure 7). One case of Kaposi's sarcoma was citizen of Mumbai (India), while another was citizen of Nigeria. Death in both cases of Kaposi's sarcoma was due to wide spread tuberculosis. The lesions of Kaposi's sarcoma were not severe and disseminated sufficient to be the cause of death. Additional infectious diseases (neither contributory nor prime cause of death) identified in this study were aspergillosis of lung (6 cases, 3%) and intestinal strongyloidiasis (3 cases, 1%). Lymphoma was found in eight (3%) cases; in seven out of eight cases lymphoma was cause of death; one case of primary hepatic lymphoma died due to widespread cryptococcosis. All were men and 7 out of eight cases showed features of diffuse, large B-cell, non-Hodgkin's lymphoma. The immunohistochemical study in these cases showed positivity for LCA, CD34, and CD68, and negativity for CD3, P53, and Bcl2. One case of primary non-hodgkin's lymphoma of liver (diffuse large T-cell type) showed large polygonal cells with a deeply eosinophilic cytoplasm and large nuclei and immunohistochemical analysis of it showed the lesion to be homogeneously positive for CD3, CD4, CD8, and CD43. In the present study 13/236 (6%) patients died due to non-AIDS-associated pathologies. In six (3%) patients cause of death was cirrhosis of liver. Three patients of cirrhosis showed abnormal liver function tests and presence of HBsAg in serum, while another three patients had history of chronic alcoholism, these cases showed features of alcoholic cirrhosis. The other prime causes of deaths were pulmonary hemorrhage (1 case), cerebral malaria (1 case) pyogenic meningitis (1 case), bacterial peritonitis (1 case), acute pyelonephritis (1 case), amyloidosis (1 case), and squamous cell carcinoma of lung (1 case). In 12 cases ante mortem diagnosis of malaria was suspected; however autopsy examination in only one case showed death due to cerebral malaria.


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 shows spindle cells and slit like vascular channels containing erythrocytes (H & E ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig7: Microscopy shows spindle cells and slit like vascular channels containing erythrocytes (H & E ×400).
Mentions: PCJ was identified in 11 (5%) patients. In only one case PCJ was cause of death, while in another 10 cases PCJ was identified in association with tuberculosis, cryptococcosis, and CMV infection. Extra pulmonary PCJ was not present in any patients. Cytomegalovirus infection was identified in 35 (16%) patients. Infection by CMV showed minor lesions, and it was contributory cause of death in these patients. CMV infection was identified in GIT (15), adrenal (8), lung (7), thyroid (4), pancreas (2), kidney (1), heart (1), and brain (1) (Figure 6). Cryptosporidial enteritis was identified in 6 (3%) cases; and it was contributory cause of death in these patients. None of the patients showed hepatobiliary cryptosporidiosis. Candidiasis was noted in 6 cases (esophagus 5 cases and stomach 1 case). 2/236 cases had Kaposi's sarcoma (1%)) (Figure 7). One case of Kaposi's sarcoma was citizen of Mumbai (India), while another was citizen of Nigeria. Death in both cases of Kaposi's sarcoma was due to wide spread tuberculosis. The lesions of Kaposi's sarcoma were not severe and disseminated sufficient to be the cause of death. Additional infectious diseases (neither contributory nor prime cause of death) identified in this study were aspergillosis of lung (6 cases, 3%) and intestinal strongyloidiasis (3 cases, 1%). Lymphoma was found in eight (3%) cases; in seven out of eight cases lymphoma was cause of death; one case of primary hepatic lymphoma died due to widespread cryptococcosis. All were men and 7 out of eight cases showed features of diffuse, large B-cell, non-Hodgkin's lymphoma. The immunohistochemical study in these cases showed positivity for LCA, CD34, and CD68, and negativity for CD3, P53, and Bcl2. One case of primary non-hodgkin's lymphoma of liver (diffuse large T-cell type) showed large polygonal cells with a deeply eosinophilic cytoplasm and large nuclei and immunohistochemical analysis of it showed the lesion to be homogeneously positive for CD3, CD4, CD8, and CD43. In the present study 13/236 (6%) patients died due to non-AIDS-associated pathologies. In six (3%) patients cause of death was cirrhosis of liver. Three patients of cirrhosis showed abnormal liver function tests and presence of HBsAg in serum, while another three patients had history of chronic alcoholism, these cases showed features of alcoholic cirrhosis. The other prime causes of deaths were pulmonary hemorrhage (1 case), cerebral malaria (1 case) pyogenic meningitis (1 case), bacterial peritonitis (1 case), acute pyelonephritis (1 case), amyloidosis (1 case), and squamous cell carcinoma of lung (1 case). In 12 cases ante mortem diagnosis of malaria was suspected; however autopsy examination in only one case showed death due to cerebral malaria.

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