Histological spectrum of liver in HIV – Autopsy study

Abstract

Introduction: Liver abnormalities are common in HIV positive patients. They are usually part of generalized process and rarely produce significant liver failure. Aim: To evaluate histological spectrum of liver disease in HIV positive patients and to ascertain if any pathologic features are widespread among HIV infection. Material & methods: Autopsy data from year 1991 to 2003 consisting of 60 HIV positive patients were evaluated. Demographic profile, clinical and laboratory data were obtained from hospital records. Macroscopic findings of all organs at autopsy were noted. Histological features of liver were studied in detail using routine H & E., Ziehl-Neelson stain for acid fast bacilli and other special stains such as PAS and GMS for fungal infection were done whenever indicated. Results: Patients were in age group 19 to 55 years with mean age of 32.1 year; male to female ratio was 4:1. Evidence of tuberculosis either pulmonary or extrapulmonary was found in 35 (58.3%) cases. On histological examination of liver, tubercular granulomas were seen in 19 (31.6%) cases of disseminated tuberculosis. Granulomas were typical caseating epitheloid cell type in 14 (73.6%) and in 5 cases granulomas were not typical. Acid fast bacilli were demonstrated in 4 (6.6%) cases, all of which showed presence of granulomas. Other histological findings were sinusoidal and centrivenular congestion in 14 (23.3%), extensive fatty change 6 (10%), portal inflammation resembling chronic hepatitis 5 (8.3%), focal necrosis 2 (3.3%), Kupffer cell hyperplasia 1 (1.6%) and metastasis from known case of adenocarcinoma of pancreas 1 (1.6%). Associated hepatitis C and B infections were seen in 4 (6.6%) and 1 (1.6%) respectively. Opportunistic infection was seen in only 1 (1.6%) case with disseminated cryptococcosis involving liver. In remaining 6 (10%) liver histology was normal. Considering cause of death, 58.3% patients died due to disseminated tuberculosis. Patients with associated hepatitis B & C infection died due to liver cirrhosis and the remaining died of miscellaneous conditions, which were not related to HIV infection. Conclusion: Histopathological findings of the liver in HIV positive patients were mainly non specific. Tuberculosis was the commonest infection noted. There was no significant mortality observed specifically related to liver involvement in these patients.