Análise das alterações hepáticas em pacientes autopsiados com a síndrome da imunodeficiência adquirida

Abstract

Objective: To analyze the histomorphometric and hepatic laboratory abnormalities of autopsied patients with AIDS, relating these data to use of ART. Methods: 62 liver fragments from patients with (n=31) and without (n=31) AIDS autopsied from 1996 and 2017, matched by age (18-49), gender and race. Patients with AIDS were analyzed according to treatment on ART (n=15) or non-ART (n=16). In the histomorphometric analysis sections were made and stained with hematoxylin-eosin, picrosirius and reticulin for steatosis, collagen fibers and type III collagen analysis, respectively. Immunostaining for CD68 was performed to evaluate the Kupffer cells density. For the analysis of pattern macro or microvesicular and topographical distribution of steatosis was considered the predominance of different histological areas: area 1, area 2 and area 3 using adapted method of Brunt. Information on direct and indirect bilirubin blood count, alanine aminotransferase, aspartate aminotransferase and platelets were obtained from the clinical records. Results: Patients with AIDS showed significantly larger steatosis percentage (26.05 vs 21.95%), collagen fibers (1.63 vs 1.01%) and type III collagen (8.68 vs 7.83%). Groups of patients with and without AIDS showed prevalence of macrovesicular pattern and topographic distribution steatosis in area 1, however no significantly difference was shown. Patients with AIDS on ART showed significantly lower steatosis percentage (25.45 vs 26.36%) and collagen fibers (1.52 vs 1.75%), as the prevalence of macrovesicular pattern and area 1 showed no significantly difference. Regarding type III collagen, patients on ART showed lower value (8.52 vs 8.77%), although no significantly difference. A lower density of Kupffer cells was shown in patients with AIDS (18.43 vs 23.26 cells/mm2) but no statistically significant difference was detected. Group on ART showed no difference in density cells compared to the group on no therapy (18.17 vs 18.17 cells/mm2). Laboratory data presented indirect bilirubin lower value for AIDS group (0.27 vs 0.91 mg/dL) and the group on ART presented greater significant values (0.45 vs 0.22 mg/dL) but still both groups presented range of normal values. Conclusion: AIDS increases steatosis and liver fibrosis. However, ART has a decreased beneficial role in hepatocyte fat accumulation and fibrosis development since the medication detains both processes.