Hepatic pathology in AIDS: a pathological study from Mumbai, India

OBJECTIVES: To assess the spectrum of hepatic disorders in AIDS, liver specimens from 171 patients (155 autopsies and 16 biopsies) were reviewed. METHODS: A retrospective and prospective study of 171 autopsy and biopsy specimens was carried out at a tertiary level hospital in Mumbai, India. RESULTS: Of the patients included in the study, 127 (74%) were male and 44 (26%) were female. The heterosexual route was the predominant mode of HIV transmission, identified in 163 (95%) patients. A total of 99 of 171 patients (58%) showed significant pathological lesions, and the most common pathological processes involving the liver appeared to be secondary to infections. None of our patients showed isolated infectious diseases of the liver. The spectrum of liver diseases identified was as follows: tuberculosis in 70 patients (41%), cryptococcosis in eight (5%), cytomegalovirus infection in six (3%), hepatitis B infection in five (3%), candidiasis in one (0.5%), malaria in one (0.5%), cirrhosis in six (3%), amyloidosis in one (0.5%) and primary hepatic lymphoma in one (0.5%). CONCLUSIONS: AIDS patients were found to have a high prevalence of underlying hepatic abnormalities. The spectrum of disease among patients with AIDS in India differs from that in developed countries. Our results suggest that hepatic tuberculosis is more common in AIDS than previously recognized, and that liver specimens should be examined routinely for the presence of acid-fast bacilli.