Post-mortem histological pulmonary analysis in patients with HIV/AIDS.
OBJECTIVE
Certain aspects of pulmonary pathology observed in autopsies of HIV/AIDS patients are still unknown. This study considers 250 autopsies of HIV/AIDS patients who died of acute respiratory failure and describes the demographic data, etiology, and histological pulmonary findings of the various pathologies.


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 197 men and 53 women were studied. The mean age was 36 years. Bacterial bronchopneumonia was present in 36% (91 cases) and Pneumocystis jiroveci pneumonia in 27% (68) of patients. Pulmonary histopathology showed acute interstitial pneumonia in 40% (99), diffuse alveolar damage in 36% (89), pulmonary edema in 13% (33), and alveolar hemorrhage in 12% (29) of patients. Multivariate analysis showed a significant and positive association between Pneumocystis jiroveci pneumonia and acute interstitial pneumonia (Odds ratio, 4.51; 95% CI, 2.46-8.24; p<0.001), severe sepsis and/or septic shock and diffuse alveolar damage (Odds ratio, 3.60; 95% CI, 1.78-7.27; p<0.001), and cytomegalovirus and acute interstitial pneumonia (Odds ratio, 2.22; 95% CI, 1.01-4.93; p=0.05).


CONCLUSIONS
This report is the first autopsy study to include demographic data, etiologic diagnosis, and respective histopathological findings in patients with HIV/AIDS and acute respiratory failure. Further studies are necessary to elucidate the complete pulmonary physiopathological mechanism involved with each HIV/AIDS-associated disease.
Soeiro
Alexandre de Matos
Ade M
Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. alexandre.soeiro@bol.com.br
Hovnanian
André L D
AL
Parra
Edwin Roger
ER
Canzian
Mauro
M
Capelozzi
Vera Luiza
VL
D000163:Acquired Immunodeficiency Syndrome / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001424:Bacterial Infections / Q000401:mortality; D001996:Bronchopneumonia / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000473:pathology*; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000401:mortality; D012131:Respiratory Insufficiency / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult