Horodetska A. Pathomorphological characteristics of immune-complex diseases of the kidneys in co-infection with HIV/viral hepatitis C

The dissertation is devoted to the identification of pathomorphological criteria for damage to the glomerular and tubulo-interstitial components of the kidneys in immune-complex kidney diseases in patients with HIV/hepatitis C co-infection. The dissertation research consisted of intragroup and intergroup analysis of clinical (genetic, age-related, immunological and nosological data) and pathomorphological (histological, histochemical and immunohistochemical data) characteristics of the selected groups. It was found that when dividing by age among patients with co-infection with HIV/hepatitis C who do not receive antiretroviral therapy (40.9±7.07 years), patients with co-infection with HIV/hepatitis C who receive antiretroviral therapy and HIV patients receiving antiretroviral therapy (average age - 37.9±6.2 years), there is no difference (p>0.05). Processing of clinical diagnoses found, that in most cases (50-66.7%) there was no information about kidney damage in any rubric of the diagnosis, in particular, anyone case with the established diagnosis "Chronic viral hepatitis C in combination with liver cirrhosis". The study of morphological features began with the glomerular component of the kidneys and revealed a predominance of the following changes among patients with HIV/hepatitis C co-infection who received and did not receive antiretroviral therapy compared to patients with HIV infection.. Evaluation of the tubulointerstitial component of the kidneys did not show significant differences between the frequency of detection of interstitial focal lymphohistiocytic infiltrates. One of the tasks of the work was to determine the role of each individual virus in the formation of the morphological substrate in HIV/viral hepatitis C co-infection. It was established that the effect of viral hepatitis C, as the main alterative factor, manifested itself in damage to the mesangium and basal membranes of capillaries (the lowest indicators in the group with mono-infection , p<0.05), and other defined morphological criteria are the result of HIV action or mutually potentiating action. both viruses. During the analysis of clinical and morphological correlations, an inverse clinical and pathomorphological dependence of the components of the morphological spectrum of immune complex kidney damage in patients with HIV/hepatitis C co-infection on the level of CD4 in peripheral blood was revealed. The results obtained with the using the criterial-based description in the pathohistological study of nephrobiopsies of kidneys from patients with co-infection with HIV/Hepatitis C indicate the feasibility of its use for detecting subnosological, preclinical changes in renal components and predicting the development of chronic kidney disease. Identifications of the immune-complex nature of kidney damage should allow for inclusion of kidney pathology as a component of the main disease: HIV infection, co-infection of HIV\Virus hepatitis C in the appropriate section, as a virus-associated immune-complex lesion when formulating clinical\patho-anatomical diagnoses, patho-histological conclusions.