The Histopathology of the Liver in HIV+ and Acquired Immunodeficiency Deficiency Syndrome (AIDS) Individuals in the HAART Era
Jonathan L Yao, Peter Schiano, Susan Morgello, Maria Isabel Fiel. Mount Sinai School of Medicine, New York City, NY
Background: Histopathological changes in the liver of AIDS patients have not been well documented in the HAART era. With longer survival, patients are now developing more advanced and varied liver disease without the opportunistic infections that they once had. Recently, an association between didanosine and non-cirrhotic portal hypertension (NCPH) due to either nodular regenerative hyperplasia (NRH) or hepatoportal sclerosis (HPS) in HIV patients has been described.
Design: Since 1999, our institution has accrued over 250 HIV+/AIDS autopsy cases via an NIH-funded Manhattan Brain Bank database. These individuals volunteer to donate their organs at post-mortem. From this cohort, we selected 77 archival liver autopsy specimens that were available for review and performed a detailed clinicopathological analysis. Grade and stage for chronic hepatitis was based on Batts and Ludwig scheme and grade and stage for steatohepatitis was based on the Brunt classification. Hepatoportal sclerosis was noted when there was phlebosclerosis and concurrent signs of portal hypertension such as splenomegaly were present.
Results: There were 40 males and 37 females; average age was 49 years (range = 20-84). Mean HIV infection duration was 11.7 years (range = 2 months-20 years). Six patients had recent (< 1 year) of HAART treatment. CD4 counts were documented for 39 patients: 14 with 0-100, 19 with 100-399, and 6 more than 400 CD4+ cells. Twenty-seven of 77 (35%) were (+) for viral hepatitis (19 HCV; 7 HCV+HBV; 1 HBV). Cirrhosis was seen in 15/27 (55%); 8 (30%) had NCPH (3NRH, 5 HPS); 4 (15%) had steatohepatitis. Only 1 of 8 patients with NCPH and positive viral hepatitis was taking HAART at the time of death. Of the 50 cases with negative viral hepatitis, 15/50 (30%) had cirrhosis; 19/50 (38%) had cryptogenic chronic hepatitis with fibrosis ranging from mild to advanced fibrosis; 11/50 (22%) had NCPH; 5/50 (10%) had steatohepatitis.
Conclusions: This study documents that significant liver disease occurs in HIV/AIDS. Our series shows that the incidence of noncirrhotic portal hypertension is high in this patient population and that chronic idiopathic hepatitis in the absence of HCV or HBV infection, and alcohol use is common. The etiology of this hepatitis remains to be elucidated. Patient involved in this study may have taken pre-HAART era medications such as didanosine, but was not documented.
Monday, March 19, 2012 8:00 AM
Platform Session: Section H, Monday Morning