Indian Journal of Pathology and Microbiology (Jul 2024)

The spectrum of pathologic lesions in spleen in patients with acquired immunodeficiency syndrome: Autopsy report of 257 patients

  • Dhaneshwar N. Lanjewar,
  • Anita N. Kavatkar

DOI
https://doi.org/10.4103/ijpm.ijpm_985_22
Journal volume & issue
Vol. 67, no. 3
pp. 553 – 558

Abstract

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Background: Human immunodeficiency virus (HIV) infection continues to persist in India over the past three decades. The involvement of the spleen in these patients has a wide array of differentials with opportunistic infections and malignancies. The spectrum of splenic lesions in patients with HIV/AIDS has not been described in the Indian literature. Materials and Methods: A retrospective study was designed to understand the spectrum of splenic pathology in patients with HIV/AIDS. The specimens of the spleen obtained at autopsy in 257 patients over a period of 29 years were systematically analyzed. Results: Among 257 patients, 197 (77%) were males and 60 (23%) were females with a heterosexual route of transmission in 246 (96%) patients. There were 236 (92%) patients from the pre-highly active anti-retroviral therapy era, while 21 (8%) patients had received highly active anti-retroviral therapy for a short duration. The most frequent splenic pathology identified was tuberculosis, noted in 135 (52%) patients, manifesting as military lesions (119 patients, 46%), tuberculous abscesses (13 patients, 5%), and tuberculosis associated with splenic infarcts (03, 1%) patients. The other pathologies noted were cryptococcosis in 17 (7%) patients, malarial infection in 13 (5%) patients, and cytomegalovirus infection in 01 (0.5%) patient. The other findings identified were chronic passive venous congestion, perivascular fibrosis, hemosiderosis, and amyloidosis. In addition, absence or depletion of lymphocyte was noted in 98 (38%) patients and in 4 (1.5%) patients diffuse large B-cell lymphoma was found. Conclusions: Patients with HIV/AIDS presenting with splenic lesions have a wide array of differentials, such as tuberculosis, opportunistic infection, and the lymphoma. This study provides a better insight into the splenic lesions in patients with AIDS in India.

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