IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME IN HIV-INFECTED PATIENTS: CLINICAL AND MORPHOLOGICAL ASPECTS
Objective. To establish the timing of Immune reconstitution inflammatory syndrome (IRIS) manifestation, the causes of death and the patterns of lymph nodes pathology in HIV-infected patients on antiretroviral therapy (ART).
Materials and methods. The medical histories, autopsy reports and lymph nodes histopathological slides of 47 HIV-infected died patients of the Gomel region for the 2012—2014 years were studied.
Results. Of 47 patients on ART 22 (46.8%) persons were manifesting IRIS. Histological features of opportunistic infections and tumors were found in lymph nodes of 59.1% of patients. 22.7% of patients manifested a progressive involution of lymphoid follicles with lymphocyte-depleted germinal centers up to the lymph tissue total angiomatosis and sclerosis. All the patients with IRIS died due to the HIV-infection worsening and opportunistic infections or tumors. The median between the day of the ART initiation and the lethal outcome in patients with IRIS was 95 days. Histopathological features of opportunistic infections in lymph nodes were found only in 16.0% of patients without manifestation of IRIS. In 68.0% of cases the early stage of HIV-lymphadenopathy characterized by the cortical and paracortical layers of lymph nodes preservation elements of follicular hyperplasia and limited follicular involution present was diagnosed. Among the patients without IRIS, every third (36.0%) death was not associated with HIV-infection.
Conclusion. In vivo biopsy of the HIV-infected patients’ lymph nodes prescribed ART will contribute to the IRIS early diagnosis.