Morphological changes in the liver in patients with pulmonary tuberculosis and HIV infection on a background of chronic hepatitis "C"

Abstract

The purpose of the study. The establishment of the features of the course and morphological manifestations of tissue responses in liver in chronic hepatitis "C" in patients with disseminated pulmonary tuberculosis on a background of HIV infection. Materials and methods. The results of the pathomorphological studies carried out on autopsy material of 11 observations of patients with diagnoses of TB associated with HIV and hepatitis "C" are reported. The comparison group was consisted of 3 patients with HIV and hepatitis "C" and one patient with generalized hematogenous tuberculosis and chronic hepatitis "C". The results of the study. Changes in the liver in the combination of TB with HIV and hepatitis "C" have a different intensity, depending on the stages of combined pathology. At the early stages of HIV infection (2B), in presence of localized tuberculosis, there is possible rapid progression of hepatitis "C" into cirrhosis of liver, which becomes the main cause of death. For the later stages of HIV infection ( 4B-5 ) there is typical the development of generalized forms of tuberculosis with the appearance of confluent caseous necrotic lesions in all organs and tissues. In these cases in the structure of the liver there are determined severe circulatory disorders, pronounced dystrophic and necrotic changes in the parenchyma, inflammatory responses caused both generalized tuberculosis and hepatitis "C". In generalization of disseminated lungs tuberculosis in the liver, monocytoid response and lymphopenia are established to take place, and at the late stage (4B - 5) stage of HIV infection there is noted aplasia of elements of lymphoid series and diffuse plazmatization. The correlation between the severity of the process and the intensity of exudative changes was revealed. Conclusion: The liver disorders in patients with HIV infection, tuberculosis and hepatitis "C" may determinative in the outcome of the disease and should be considered when choosing a scheme of etiotropic and pathogenetic treatment and the staging of therapy.