Особенности поражения легких при коинфекции ВИЧ/SARS-CoV-2 у пациентов с разной степенью иммунодефицита

Abstract

Introduction.The development of the COVID-19 pandemic along with the ongoing pandemic of HIV infection has raised the question of how these two diseases interact. This study examines morphological changes that occur in lung tissue during HIV/SARS-CoV-2 coinfection in patients with varying levels of immune status. Materials and methods. The study included 6 deceased HIV-infected patients who had a clinical diagnosis of COVID-19, which was confirmed postmortem by the detection of SARS-CoV-2 RNA in lung samples obtained during biopsy using polymerase chain reaction. Three patients were with newly diagnosed HIV infection; three patients had a relatively intact immune status (CD4+ more than 200 cells/μl) and no opportunistic infection and received effective antiretroviral therapy. To perform histologic examination, we used histochemical stains by Van Gieson, Grocott, Ziehl-Neelsen, PAS reaction as well as immunohistochemistry (IHC) with antibodies against SARS-CoV-2 nucleocapsid and cytomegalovirus. Results. The macroscopic picture in all cases was characterized by a decreased airiness and compaction of the lung tissue. Microscopically, patients with newly diagnosed HIV demonstrated diffuse alveolar damage (DAD) with pneumocystis pneumonia and cytomegalovirus infection. Nucleocapsid of SARS-CoV-2 was revealed in hyaline membranes and alveolar cells. In patients with controlled HIV, we detected manifestations of various phases of DAD and/or disseminated intravascular coagulation (DIC) syndrome with a predominant distribution of SARS-CoV-2 in macrophages and blood vessels. Conclusion. Lung damage in severe HIV-associated immunodeficiency was determined by the combination of direct cytopathic effect of coronavirus and opportunistic pathogens. In controlled HIV and relatively intact immune status, immune mediated action of SARS-CoV-2 could take place manifesting in diffuse alveolar damage and making the morphological picture comparable to that in HIV-negative patients.