Etiologic, demographic and histopathological analysis about autopsies from HIV/AIDS patients – about two decades of research comparing results before and after antiretroviral therapy advent

Abstract

Objectives: This study considers 489 autopsies of HIV/AIDS patients who died with 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. Bronchopneumonia was present in 43% and Pneumocystis jiroveci pneumonia in 38% of patients. Pulmonary histopathology showed diffuse alveolar damage in 31% and acute interstitial pneumonia in 23%. Multivariate analysis showed a significant and positive association between diffuse alveolar damage and: disseminated tuberculosis, cirrhosis and sepsis; and acute interstitial pneumonia and: Pneumocystis jiroveci pneumonia and cytomegalovirosis. After introduction of antiretroviral therapy we observed an increase in 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 to 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.