Liver infection and COVID-19: the electron microscopy proof and revision of the literature

OBJECTIVE: COVID-19, the newly emerging infectious disease, has been associated with acute liver injury, often related to progression to severe pneumonia. The association between moderate-severe liver injury and more severe clinical course of COVID-19 has suggested that liver injury is prevalent in severe than in mild cases of COVID-19, while no difference in liver involvement has been reported between survivors and non-survivors. The spectrum of liver involvement during COVID-19 ranges from an asymptomatic elevation of liver enzymes to severe hepatitis. Only rarely, cases with acute hepatitis have been reported in the absence of respiratory symptoms. Both epithelial and biliary cells possess the angiotensin-converting enzyme-2 receptors that SARS-CoV-2 uses to be internalized. However, to our knowledge, no ultrastructural identification of the virus in liver cells has been reported to date. Here we provide evidence of SARS-CoV-2 in the liver of two patients, a 34-year-old woman and a 60-year-old man with COVID-19.PATIENTS AND METHODS: We investigated two patients with COVID-19 showing several virions within cytoplasmic vacuoles of cholangiocytes and in endothelial cells of hepatic sinusoids. In both patients, we performed histological and ultrastructural examinations by liver biopsy. After two months, both patients were free of symptoms, and the SARS-CoV-2 infection had resolved.RESULTS: Liver biopsy histological and ultrastructural examination showed liver injury and several virions within cytoplasmic vacuoles of cholangiocytes and in endothelial cells of hepatic sinusoids.CONCLUSIONS: Although most studies in COVID-19 have been focused on the lungs, recently, cholestatic liver pathology has been introduced in the spectrum of pathological changes related to COVID-19. To the best of our knowledge, those presented in this paper are the first images of hepatic SARS-CoV-2 infected liver cells. Our findings suggest a role for cholangiocytes and biliary structures in the COVID-19

Vaccines against HPV in people living with HIV: a review

Human Papilloma Virus (HPV) infection represents the most common sexually transmitted infection worldwide. The best weapon to control the HPV infection is the primary prevention that includes interventions related to lifestyle and sexual habits and HPV-vaccination. HPV vaccination must be recommended not only for young girls, but also for boys, MSM and HIV-infected people. People Living with HIV (PLWHA) have high rates of persistent HPV infection if compared with HIV-uninfected people. Several data from HIV negative population have confirmed vaccine safety and efficacy, but there is limited data available on the efficacy of the vaccine among HIV-infected people. In this review, we considered the studies published about anti-HPV vaccination in PLWHA that we found performing a research on PUBMED (Bethesda, MD, USA) with the aim to point out the main aspects of vaccination in this particular population

Epstein Barr Virus related cancer in people living with HIV: a review of the literature

The introduction of Highly Active Antiretroviral Therapy (HAART) has modified the natural history of Human Immunodeficiency Virus (HIV) infection, leading to an increase in the life expectancy of the patients living with HIV (PLWH). Similar to other oncogenic viruses, EBV increases the risk of developing cancer in immune-depressed hosts, including HIV-infected people. The adherence to anti-retroviral therapy (ART) is important in the management of cancer in HIV-positive patients even if ART has a less favorable impact on EBV related tumors if compared with its impact on AIDS-defining cancers. This review is focused on the epidemiology, pathogenesis, diagnosis, management and therapy of EBV-associated tumors in the setting of HIV infection

Hodgkin’s lymphoma in people living with HIV: epidemiology and clinical management

e1295-Hodgkin’s lymphoma in people living with HIV- epidemiology and clinical managementAfter the introduction of combination Antiretroviral Therapy (cART), survival of people living with HIV/AIDS (PLWH) has improved, bringing to the appearance of new health problems. Among these problems, there is an increased risk to develop malignancies. Hodgkin’s lymphoma (HL) is a curable malignancy, suspected to be associated with Epstein-Barr Virus (EBV) infection. Median age of HL incidence in PLWHs is 30 years, after approximately 7 and a half years from the HIV infection diagnosis. HL is significantly more frequent in PLWHs than in the general population. As a matter of fact, the incidence of this disease is 8-fold higher than the general population during the pre-cART era, and the difference worsened, reaching a 13-fold higher incidence during the cART era. Early diagnosis is crucial. The detection of cancer in an early stage improves the outcome of patients, indeed. The aim of this paper was to review the epidemiological characteristics and the diagnostic and therapeutic management of HL in HIV infected patients