AIDS and the pancreas in the HAART era: a cross sectional study

BACKGROUNDS The aim of this study is identify the main morphological patterns of the pancreas in AIDS patients in use of Higly Active Antiretorviral Therapy (HAART). METHODS We conducted a cross sectional study in the year of 2010. The inclusion criteria were patients older than 18 years who died of AIDS with the use of HAART (2006-2009) and underwent to autopsy . They were compared with a group of 109 patients who died of AIDS in 1995 before the HAART therapy. All the autopsies were made in the Death Verification Service of São Paulo. RESULTS The HAART group presented pancreas abnormalities lighter than no HAART users. In the HAART group, histology shows: reduction of zymogen granules in the acinar cells (ZG) higher percentage of cases, "dysplasia-like" presents lower and pancreatic acinar atrophy, presents higher percentage of cases compared to no HAART group. The exocrine pancreas in treated patients was distinguished by the high level of atrophy, sharp reduction of zymogen granules and high level of apoptosis, reflecting degeneration and lower level of protein-caloric malnutrition. CONCLUSIONS The islets of Langerhans in HAART group were increased in number and volume and with high level of nuclear dysplasia. The antiviral therapy and a longer survival resulted in a higher atrophy and reduction of enzymes, increasing the apoptosis and generated important changes in the pancreatic islets, probably resulting in clinical laboratory repercussion.We found no evidence of pancreatic histopathological lesions secondary to antiretroviral therapy.