title: [Morphological characteristics of inflammation in HIV-associated pulmonary tuberculosis with regard to the expression of myeloperoxidase].
abstract: OBJECTIVE
  to characterize the morphological features of inflammation and the degree of myeloperoxidase expression in the lung of patients who died from HIV-associated tuberculosis (TB).
  
  
  METHODS
  Autopsy lung tissue specimens from 229 patients with HIV-associated TB were examined. A comparison group consisted of dead TB mono-infected patients (n = 30). Dead HIV/TB co-infected patients were divided into subgroups: 1) 50 patients with Stage 4A-4B and a CD4(+)-lymphocyte count of more than 200 cells/µl; 2) 54 with Stage 4B-4C and a CD4(+)-lymphocyte count of 100 to 200 cells/µl; 3) 125 with Stage 4C-5 and a CD4(+)-lymphocyte count of less than 100 cells/µl. Histological and immunohistochemical examinations of lung slices were performed using antibodies to myeloperoxidase (MPO).
  
  
  RESULTS
  The predominant types of an inflammatory response were revealed according to the level of CD4+ lymphocytes. The lungs in Subgroup 1 showed a predominant typical granulomatous response (82%). Subgroup 2 exhibited an exudative-productive inflammatory response (57.4%) while Subgroup 3 displayed an alterative necrotic type (92.8%). Subgroup 3 showed the most marked reduction in lymphocyte numbers in the areas of inflammation, which was accompanied by a significant increase in the relative density and other morphometric parameters of MPO-positive macrophages and granulocytes in the inflammatory infiltration zones and alveolar walls.
  
  
  CONCLUSIONS
  The identified changes in the lungs suggest that there is a decline in the magnitude of a delayed type hypersensitivity reaction, a progression of alterative necrotic processes as CD4(+) lymphocytes decrease in the systemic blood flow, and an increase in the proportion of functionally immature macrophages in the areas of inflammation, which reflects a substantially impaired local immune response to the persistence of M. tuberculosis in HIV infection.
authors: Volgograd State Medical University, Ministry of Health of the Russian Federation.
authors: L S
authors: LS
authors: Bykhalov
authors: Volgograd State Medical University, Ministry of Health of the Russian Federation; Volgograd Medical Research Center, Volgograd, Russia.
authors: A V
authors: AV
authors: Smirnov
mesh_terms: D000328:Adult; D001344:Autopsy; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D005260:Female; D015870:Gene Expression; D006098:Granulocytes / Q000473:pathology; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications / Q000235:genetics / Q000473:pathology* / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000235:genetics / Q000473:pathology* / Q000821:virology; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity; D009195:Peroxidase / Q000096:biosynthesis* / Q000235:genetics; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000235:genetics / Q000382:microbiology / Q000473:pathology* / Q000821:virology
chemical_list: D009195:Peroxidase