Lung pathology in Human Immunodefiency Virus positive patients an autopsy study

Abstract

Aim: To accurately describe the lung pathology occurring in deceased Human Immunodeficiency Virus (HIV) positive individuals by way of an autopsy study and to attempt to do a clinicopathological correlation. Materials and methods Sixty one subjects were autopsied at Parirenyatwa Hospital with forty two (42) showing lung pathology; thus the sample size used for the study was forty two (42). Lungs were preserved with formalin and three (3) sections per lobe taken and subjected to hematoxylin and eosin (H&E) stain. Additional special stains were applied as required after review of the H&E. Results: By histopathological analysis bronchopneumonia was the leading cause of death from lung disease observed in eleven cases (26%), followed by pneumocystis jiroveci pneumonia seven (17%) then pulmonary tuberculosis (PTB) six (14%) cases. Mixed disease of pulmonary tuberculosis, bronchopneumonia and pneumocystis jiroveci pneumonia (PTB/BPN/PJP) and pulmonary tuberculosis and bronchopneumonia (PTB/BPN) were seen in two (5%) instances Pulmonary embolism (PE) was a surprising find accounting for six cases (14%) with an additional two (5%) cases being found mixed with hilar node tuberculosis (PE/PTB) and bronchopneumonia (PE/PTB). 3 Conclusion: There is a tendency to favour diagnosing pulmonary tuberculosis over PJP , two diseases with similar presenting signs and symptoms but very different treatment regimes. All cases of PJP were diagnosed as PTB. There is a reluctance to start treatment despite there being lack of further tests such as BAL to rule out PJP. Such reluctance is not shown with antituberculosis treatment. Pulmonary embolism remains under diagnosed in HIV. Methods to identify and stratify risk in HIV positive patient need to be devised.