The spectrum of hepatic pathology in HIV infected adults at autopsy at the University Teaching Hospital, Lusaka

Abstract

With the increasing availability of highly active antiretroviral therapy (HAART), people are living longer with human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy (ART) for HIV has resulted in a great reduction of acquired immunodeficiency syndrome (AIDS)-related deaths. In the ART-era, liver disease has become one of the most common non-AIDS related cause of death among HIV infected patients. In those co-infected with hepatitis C virus (HCV), end-stage liver disease has emerged as one of the leading causes of morbidity and mortality in patients living with HIV. The true extent and variety of liver pathology affecting HIV-infected adults in Zambia remains largely unknown. The objective of this study was to describe the spectrum of hepatic pathology in HIV infected adults at autopsy at a tertiary referral center. Methods: A total of 139 paraffin embedded postmortem liver biopsies from 139 HIV seropositive adults who died at the University Teaching Hospital (UTH) between 2006 and 2013 were evaluated. Serial sections from each liver biopsy where stained with hematoxylin and eosin, Masson’s trichrome, Periodic acid Schiff and methenamine silver stains. A Ziehl Neelsen stain was done where tuberculous infection was suspected histologically. Histology was then reviewed without blinding to the clinical details. Data was then compiled and examined using SSPS version 20.0. Results: The median age of the patients was 36 years (IQR 11). 64% (89) were male. Liver pathology was found in 93.5% of the patients with only 6.5% demonstrating normal histology. The commonest histologic findings were portal tract fibrosis and non-specific portal chronic inflammation, 73% and 60.3% respectively. Caseating granulomatous hepatitis was seen in 41.6% of the patients and macro-vesicular steatosis 26.5%. Females were significantly more likely to have steatosis than males (p<0.001). Non-specific sinusoidal dilatation and congestion were seen in 21.9% of the patients, parenchyma necrosis 16.7% and chronic hepatitis 8.8%. Parenchymal necrosis was v associated with being on HAART (p=0.004). The only neoplasm seen was cavernous hemangioma in 1.5% of the patients. Conclusion: Liver pathology is common in HIV-infected adults at autopsy at the UTH. The spectrum of hepatic pathology in HIV positive patients at UTH is almost exclusively due to structural change and infection/inflammation. Of the infectious/inflammatory causes, tuberculous infection presenting as granulomatous hepatitis is the most common. Female gender and HAART are associated with steatosis and parenchymal necrosis respectively. AIDS defining neoplasms seem uncommon in the liver.