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Association of hepatic veno-occlusive disease with the acquired immunodeficiency syndrome.

AIMS
Observation of a patient with the acquired immunodeficiency syndrome and veno-occlusive disease (VOD) at autopsy prompted us to review the liver pathology of autopsied patients with human immunodeficiency virus seropositivity and/or acquired immunodeficiency syndrome (HIV/AIDS) to determine the frequency of occurrence of VOD and the circumstances in which it arose.


METHODS
the patients studied had been autopsied at The Johns Hopkins Hospital, a referral center, between April 1981 and July 1993. We reviewed 275 adult HIV/AIDS patients autopsied with liver slides available for evaluation. Twenty cases fulfilled the pathologic criteria for VOD, central vein obliteration and sclerosis, sinusoidal congestion and fibrosis, and perivenular hepatocellular degeneration and necrosis. The autopsy cases were compared for age, race, gender, duration of HIV infection, and risk factor for the acquisition of HIV infection. The clinical and pathologic features of the 20 cases with VOD were reviewed.


RESULTS
of the 275 HIV/AIDS patients, 20 (7.3%) had VOD. The average age was 41 yr (range 30-58) and most cases were black males (15 black, 5 white, and 18 male). The duration of HIV infection ranged from 6 mo to 8 yr (mean, 19 mo). The risk factor for acquiring HIV infection was primarily intravenous drug abuse (12 of 20, 60%). Six patients had homosexual or bisexual contacts, and two had other or unknown risk factors. In contrast, among the total of 275 HIV/AIDS autopsied patients reviewed, only 72 (26%) reported intravenous drug abuse whereas 157 (57%) individuals listed homosexual or bisexual contacts as a risk for developing HIV infection. Forty-six patients (17%) had other or unknown means of HIV infection. Statistical analysis by risk factor showed that intravenous drug abuse was statistically significant as a predictor for the development of VOD in an HIV/AIDS patient (P < 0.005).


CONCLUSIONS
VOD of the liver can be seen in patients with HIV/AIDS and is associated with intravenous drug abuse.