The document discusses pathology associated with HIV and AIDS, including: 1. It provides an overview of the global HIV/AIDS epidemic and prevalence rates over time in South Africa. 2. It describes the clinic-pathologic presentations of different stages of HIV infection, including common infections and conditions associated with different CD4 count ranges. 3. It discusses anatomical and clinical presentations of various opportunistic infections and cancers associated with advanced HIV, including tables outlining cardiovascular, dermatological, neurological, and other manifestations. 4. It presents several images of pathologic findings from HIV-infected patients, such as lesions from toxoplasmosis, Kaposi's sarcoma, lymphoma, and other conditions.

1. Pathology of HIV and HIV Associated
Diseases
Introductory session
Prof. M. Garcia-Jardón

2. "During the summer of 1981, an unknown
pop singer named Madonna began singing
at night cafés of the city of New York,
emerged a new channel dedicated to music
(MTV) video cable and appeared the first
report on the scientific literature today
disease known as AIDS" 1.

3. "Global epidemic of HIV/AIDS is an unprecedented
crisis that requires an unprecedented response."
In the detail required solidarity; between the
healthy and the sick, between rich and poor-
And above all, between richer and poorer nations.
We have 30 million orphans. "How many more we
get to wake up?"
Kofi Annan
United Nations Secretary-General
1997-2007

4. World wide prevalence of HIV infection in 2008

5. Annual Prevalence of HIV in South Africa
(From: Human Sciences Research Council)
Year VIH Prevalence 95% CI
%
2002 11.4 10.0 – 12.7
2005 10.8 9.9 – 11.8
2008 10.9 10.0 – 11.9

6. Clinic-Pathologic Presentation of HIV infection (1) (Bartlet &
cols, 2008)
Primary HIV Infection
Asymptomatic
Acute Retroviral Syndrome
Clinical Stage 1
Asymptomatic
Persistent Generalized Lymphadenopathy (PGL)
Clinical Stage 2
Moderate, unexplained weight loss (< 10% presumed or
measured body weight)
Recurrent Respiratory Infections (pharyngitis, otitis, sinusitis,
bronchitis etc.)
Herpes zoster
Angular Cheilitis
Recurrent buccal ulcers
Papular pruritic eruptions
Seborrheaic Dermatitis
Fungal nail or skin infections

7. Clinic-Pathologic Presentation of HIV infection (2)
(Bartlet & cols, 2008)
Stage 3 Clinic
Conditions where presumptive diagnosis, based on clinic signs or
laboratory tests:
Severe weight loss (> 10% body mass index)
Unexplained diarrhoea of more then 1 month duration.
Unexplained, Persistent Fever inexplicable (constant and/or
intermittent) of more than one month duration.
Oral candidiasis
Oral Hairy leucoplakia
Pulmonary Tuberculosis diagnosed over the last two years.
Severe Bacterial Infections (empyema, pneumonía, meningitis,
osteomyelitis, etc).
Acute, necrotizing, ulcerative estomatitis, gingivitis,
periodontitis.
Conditions where diagnosis needs to be confirmed by laboratory:
Unexplained Anaemia (< 8g/dl) and/or neutropenia (< 500/mm3)
and/or trombocytopenia (< 50 000/ mm3) of a month or more
duration.

8. Clinic-Pathologic Presentation of HIV infection (3)
(Bartlet & cols, 2008)
Clinic Stage 4
Asymptomatic
Persistent Generalized Lymphadenopathy (PGL)
Conditions where presumptive diagnosis could be done, based on
clinic signs or laboratory tests:
Wasting syndrome by HIV, Pneumocystis pneumonia,
Recurrent or Radiologic severe Pneumonía
Chronic Infection (> 1 month) by Herpes simplex virus
(any location)
Oesophageal Candidiasis, Kaposi’s sarcoma, extra pulmonary
tuberculosis
CNS Toxoplasmosis
HIV Encefalopathy

9. Anatomo-clínic Presentation of HIV infection (4)
(Bartlet y cols, 2008) (17)
Conditions where laboratory diagnostic is necessary:
Extra pulmonary Cyptococosis (Meningitis included)
Disseminated non-tuberculous mycobacterium infection
Multi focal progressive Leuco-encephalopathy
Tracheal, bronchial and/or pulmonary Candidiasis
Criptosporidiosis
Isosporidiosis
Herpes simplex visceral
Infection by Cytomegalovirus
Any systemic disseminated mycosis
Recurrent Septicemia due to non typhoid salmonella.
Non- Hodgkin or B-cell Cerebral Lymphoma
Invasive Cervical Carcinoma
Visceral Leishmaniasis

10. CD 4 Infectious Complications Complications Non- Infectious
Count Complications
Correlation between
> 500 / mm 3 Acute Retroviral General, . Persistent
complications and CD4 Syndrome Lymphadenopathies
count Vaginal Guillain-Barré Syndrome
Candidiasis Myopathies
(Global HIV/AIDS 2008) Aseptic Meningitis
200 – 500 / mm 3 Bacterial Pneumonia Dysplasia cervix & anal
Pulmonary Tuberculosis Anal & cervical Cancer
Herpes zoster B-cell Lymphoma
Oropharyngeal Anaemia
Candidiasis Idiopathic Thrombocytopenic Purpura
TABLE 5 Cryptosporidiasis Hodgkin’s Lymphoma
Kaposi’s Sarcoma Interstitial Lymphocytic Pneumonia
Hairy Leucoplakia
< 200 / mm 3 Pneumocystis Pneumonia Wasting
Disseminated Peripheral Neuropathy
Histoplasmosis & HIV Associated Dementia
coccidioidomicosis Cardiomyopathy
Miliar y extra pulmonary Vacuolar Mielopathy
Tuberculosis Progressive Polyradiculopathy
Multi focal progressive non-Hodgkin Lymphoma
Encephalopathy
< 100 / mm 3 Herpes simplex
disseminated
Toxoplasmosis
Criptococosis
ChronicCriptosporidiosis
Microsporidiosis
Esophagitis by Candida
< 50 / mm3 Citomegalovirus Primary CNS Lymphoma
diseminado
Complejo Micobacterium
avium diseminado

11. TABLE 6:
Main Cardiovascular Manifestations
Pericardial effusion Idiopathic
Myocardial Affections Infectious (viral, bacterial, TB)
Endocarditis Neoplastic (Kaposi’s sarcoma, non-
Tumours Hodgkin lymphoma)
Pulmonary Hypertension & Right Myocarditis (idiopathic/lymphocytic,
ventricular dysfunction infectious specific)
Early Arteriosclerosis & Coronary Dilated Cardiomyopathy & Left
diseases ventricular dysfunction
Adverse Drug Effect Marantic (thrombotic, non-bacterial)
Vascular Disease due to autonomous endocarditis
dysfunction Infectious endocarditis
Kaposi’s Sarcoma
Non-Hodgkin lymphoma
Primary or Secondary (COR pulmonale
chronic) cardiomyopathy
Hyperlipidemias
Pro-arrhythmias

12. Table 7: Classification of vascular lesions in
infected HIV patients (Chetty,J. Clin. Path. 2001)
Infectious Vasculitis :
Cytomegalic inclusion Virus
Herpes Zoster Virus
Toxoplasmosis
Pneumocystis
Salmonella
Mycobacterium tuberculosis
Non Infectious Vasculitis
Polyarteritis Nodosa-like Syndrome and other systemic, necrotizing
vasculitis
Hipersensitivity Vasculitis due to lympho-granulomatous lesions and
immune
proliferative, angiocentric lesions
Primary CNS Angeítis
Vasculopathy of great vessels
Miscellaneous.

13. TABLE 8: Most common Cutaneous Lesions in
HIV/AIDS patients (Grayson & all, 2005)
- Non-infectious Dermatosis :
- HIV Exanthema
- Papular Dermatitis (Popular pruriginous eruption)
- Seborrheic Dermatitis Eruption type
- Psoriasis
- Eosinophylic Folliculitis
- Leucocytoclastic Vasculitis
- Xerosis
- Drug Reaction
- Additional Dermatoses such as Granuloma
annulare, atopic dermatitis, photo-sensitivity etc.

14. TABLE 9: Commonest cutaneous lesions in
HIV/AIDS patients (Grayson & all, 2005)
- Cutaneous Infections : Sub-classified in 5 types:
Type 1: folliculitis, furunculosis by Staf. aureus &
bacillary angiomatosis by Bartonella quintana in patients
with CD4 < 100 cell/mm3
Type 2: Scabies (Norwegian type), condylomas by HPV,
verrucas, infections by cytomegalovirus,
moluscum contagious & herpes simplex/zoster infections
Type 3: Fungal (arternatia, aspergillus, mucor, criptococo,
histoplasma etc) & mycobacterias (avium, intracelular)
Type 4: Pseudomonas, histoplasmosis, coccidioidomicosis,
blastomicosis, nocardia, aspergilus, cryptococus, candida,
mucor etc.
Type 5: Hairy Leucoplasia due to Epstein Bar virus and
candidiasis

15. TABLE 10: Common Cutaneous Lesions in HIV/AIDS
positive patients (Grayson & all, 2005)
- Neoplasias:
Kaposi’s Sarcoma
B-cell Lymphomas
Large cell Non-Burkitt’s Lymphomas
Mycosis fungoides
Squamous cell carcinoma, oral, anal,
rectal,

16. TABLE 11: Neurological complications of HIV/AIDS. Ed Saunders,
1997 (27)
Comparison between neurological infections before and after 1980
Before 1980 After 1980
Common Rare Common Rare
Bacterial Listeria Mycobactrium Listeria,
Nocardia TB Mycobacterium
Nocardia
Virals H. Simplex Papovavir Papovavir H. Simplex
Varicela CMV H. Simplex
zoster
Fungal Cryptococus Aspergillus Aspergillus
Cryptococus Histoplasma
Parasitics Toxoplasma Toxoplasma

17. Vasculitis macroscopic findings in an HIV infected body

18. Necrotic cardiac lesion by toxoplasma

19. Acute fatty liver of pregnancy

20. Cryptococcal infection and vascular thrombosis

21. Cryptococcal infection. Grocott stain

22. Kaposi’s sarcoma of the index finger

23. Burkitt’s lymphoma of the ovary

24. Infection by P. jiroveci. Lung biopsy

25. Intracranial mass with bone destruction

26. Macroscopic appearance of removed lesion
from previous CT-scan image

27. Primary lymphoma of the brain, infiltrating skull
bone (previous case)

28. Feed back:
• After completion of the module, the
students should fill in the questionnaire
giving us feed-back on what they learnt,
what would they like to change/modify,
what are the pros, cons and gaps of the
course etc.