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PATHOLOGY of HIV/AIDS 32Nd Edition

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PATHOLOGY of HIV/AIDS 32Nd Edition PATHOLOGY OF HIV/AIDS 32nd Edition by Edward C. Klatt, MD Professor of Pathology Department of Biomedical Sciences Mercer University School of Medicine Savannah, Georgia, USA July 20, 2021 Copyright © by Edward C. Klatt, MD All rights reserved worldwide 2 DEDICATION To persons living with HIV/AIDS past, present, and future who provide the knowledge, to researchers who utilize the knowledge, to health care workers who apply the knowledge, and to public officials who do their best to promote the health of their citizens with the knowledge of the biology, pathophysiology, treatment, and prevention of HIV/AIDS. 3 TABLE OF CONTENTS 3.................................................................................................................................2 CHAPTER 1 - BIOLOGY AND PATHOGENESIS OF HIV INFECTION.....6 INTRODUCTION......................................................................................................................6 BIOLOGY OF HUMAN IMMUNODEFICIENCY VIRUS................................................10 HUMAN IMMUNODEFICIENCY VIRUS SUBTYPES.....................................................29 OTHER HUMAN RETROVIRUSES....................................................................................31 EPIDEMIOLOGY OF HIV/AIDS.........................................................................................36 RISK GROUPS FOR HUMAN IMMUNODEFICIENCY VIRUS INFECTION.............46 NATURAL HISTORY OF HIV INFECTION......................................................................47 PROGRESSION OF HIV INFECTION................................................................................52 IDIOPATHIC CD4+ T-LYMPHOCYTOPENIA.................................................................57 PREVENTION OF HIV TRANSMISSION..........................................................................58 TREATMENT FOR HIV/AIDS.............................................................................................61 CHAPTER 2 - DIAGNOSIS OF HIV/AIDS.......................................................81 DIAGNOSTIC TESTS FOR HUMAN IMMUNODEFICIENCY VIRUS.........................81 PEDIATRIC HIV INFECTION AND AIDS.......................................................................107 CRITERIA FOR AIDS-RELATED COMPLEX...............................................................111 OTHER CAUSES OF IMMUNOSUPPRESSION.............................................................112 CHAPTER 3 - OPPORTUNISTIC INFECTIONS IN HIV/AIDS.................113 PNEUMOCYSTIS JIROVECI INFECTIONS...................................................................113 CYTOMEGALOVIRUS INFECTIONS.............................................................................117 MYCOBACTERIAL INFECTIONS...................................................................................120 CRYPTOCOCCUS INFECTIONS......................................................................................130 HERPESVIRUS INFECTIONS...........................................................................................132 TOXOPLASMA GONDII INFECTIONS...........................................................................139 HISTOPLASMA CAPSULATUM INFECTIONS.............................................................141 4 COCCIDIOIDES IMMITIS INFECTIONS.......................................................................144 GASTROINTESTINAL PROTOZOAL INFECTIONS...................................................145 BACTERIAL INFECTIONS................................................................................................148 CHAPTER 4 - NEOPLASMS ASSOCIATED WITH HIV/AIDS..................160 KAPOSI SARCOMA.............................................................................................................160 MALIGNANT LYMPHOMAS............................................................................................163 OTHER NEOPLASMS.........................................................................................................170 CHAPTER 5 - ORGAN SYSTEM PATHOLOGY IN HIV/AIDS.................174 RESPIRATORY TRACT PATHOLOGY IN HIV/AIDS..................................................174 GASTROINTESTINAL TRACT PATHOLOGY IN HIV/AIDS.....................................196 CENTRAL NERVOUS SYSTEM PATHOLOGY IN HIV/AIDS....................................218 PERIPHERAL NERVE AND MUSCLE PATHOLOGY IN HIV/AIDS.........................238 OPHTHALMIC PATHOLOGY IN HIV/AIDS..................................................................246 LYMPH NODE PATHOLOGY IN HIV/AIDS..................................................................251 SPLEEN IN HIV/AIDS.........................................................................................................258 BONE MARROW AND PERIPHERAL BLOOD IN HIV/AIDS.....................................260 THYMUS IN HIV/AIDS.......................................................................................................265 ENDOCRINE ORGAN PATHOLOGY IN HIV/AIDS......................................................267 HEPATOBILIARY SYSTEM PATHOLOGY IN HIV/AIDS..........................................270 CARDIOVASCULAR PATHOLOGY IN HIV/AIDS.......................................................279 RENAL PATHOLOGY IN HIV/AIDS................................................................................286 GENITOURINARY PATHOLOGY IN HIV/AIDS...........................................................291 DERMATOPATHOLOGY IN HIV/AIDS..........................................................................295 PANCREAS IN HIV/AIDS...................................................................................................311 PREGNANCY AND THE PLACENTA IN HIV/AIDS.....................................................313 HEAD AND NECK PATHOLOGY IN HIV/AIDS............................................................314 BONE, JOINT, AND SOFT TISSUE PATHOLOGY IN HIV/AIDS...............................317 5 CYTOPATHOLOGY IN HIV/AIDS...................................................................................321 PEDIATRIC HIV/AIDS........................................................................................................322 CHAPTER 6 - SAFETY PROCEDURES WITH HIV/AIDS.........................331 EDUCATIONAL GOALS.....................................................................................................331 UNIVERSAL PRECAUTIONS............................................................................................333 OSHA REGULATIONS........................................................................................................335 OCCUPATIONAL AND NON-OCCUPATIONAL HIV EXPOSURES.........................340 INVASIVE AND SURGICAL PROCEDURES..................................................................343 THE SURGICAL PATHOLOGY LABORATORY..........................................................345 THE HIV/AIDS AUTOPSY..................................................................................................346 ATHLETICS AND HIV INFECTION................................................................................350 CHAPTER 7 - MEDICOLEGAL ISSUES AND HIV/AIDS...........................351 DEATH INVESTIGATION AND CERTIFICATION IN HIV/AIDS..............................351 CAUSE AND MODE OF DEATH WITH HIV INFECTION...........................................352 ETHICAL ISSUES ARISING FROM THE HIV/AIDS PANDEMIC.............................354 HIV TESTING AND COUNSELING..................................................................................357 TABLES 1 - 10.....................................................................................................364 6 CHAPTER 1 - BIOLOGY AND PATHOGENESIS OF HIV INFECTION INTRODUCTION The human immunodeficiency virus (HIV) was unknown until the early 1980's when increasing numbers of cases of unusual opportunistic infections and Kaposi sarcoma in persons with lymphadenopathy in the setting of impaired cell-mediated immunity were reported.[1,2] Since then HIV has infected millions of persons in a worldwide pandemic. The result of HIV infection is relentless destruction of the immune system leading to onset of the acquired immunodeficiency syndrome (AIDS). The AIDS pandemic has already resulted in the deaths of over half its victims. All HIV-infected persons are at risk for illness and death from opportunistic infectious, neoplastic complications, and comorbidities because of the inevitable manifestations of AIDS as well as long term treatment of HIV.[3,4] Once HIV infection became established in humans, the spread of HIV has been driven by multiple factors. The advent of quick air travel in the 20th century provided a means for spread not present in past human pandemics. Urbanization has led to increased numbers of persons at risk in close proximity. Human sexual practices with promiscuity have included a larger number of persons in populations around the world. A practical and easily available means for delivery of drugs of abuse through injection became more widespread in the 20th century.[3] The AIDS pandemic has evolved over time, with four main phases of evolution. In the initial phase, HIV emerged from endemic rural areas to spread among urban populations at an accelerating rate. In the second phase, dissemination occurred and involved definable risk groups. Behaviors in these risk groups, including sexual promiscuity and injection drug use, led to the third phase of escalation, which occurred through the 1980’s. A fourth phase of stabilization has occurred in some
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