The post-mortem pathology of HIV-1-infected African children

Chakraborty, Rana; Pulver, Aaron; Pulver, Laurie S.; Musoke, Rachel; Palakudy, Tresa; D'Agostino, Angelo; Rana, F.

doi:10.1179/027249302125000841

Cited by 18 publications

(13 citation statements)

References 24 publications

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“… 1 , 4 – 7 The occurrence of bacterial infections in patients with HIV/AIDS is also a reflection of their immunosuppression, and the most frequent pathogens are Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa . 1 – 5 Rana et al analyzed autopsies in Kenya and showed an association between tuberculosis and BBP in 96% of patients with HIV/AIDS. 6 Even in pediatrics studies, BBP appeared as the major cause of ARF in autopsies of patients with HIV/AIDS.…”

Section: Discussionmentioning

confidence: 99%

Post-Mortem Histological Pulmonary Analysis in Patients with HIV/AIDS

Soeiro

Hovnanian

Parra

et al. 2008

Clinics

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Soeiro AM, Hovnanian ALD, Parra ER, Canzian M, Capelozzi VL. Post-mortem histological pulmonary analysis in patients with HIV/AIDS. Clinics. 2008;63:497-502. OBJECTIVES:Certain aspects of pulmonary pathology observed in autopsies of HIV/AIDS patients are still unknown. This study considers 250 autopsies of HIV/AIDS patients who died of acute respiratory failure and describes the demographic data, etiology, and histological pulmonary findings of the various pathologies. METHODS:The following data were obtained: age, sex, and major associated diseases (found at the autopsy). Pulmonary histopathology was categorized as: diffuse alveolar damage; pulmonary edema; alveolar hemorrhage; and acute interstitial pneumonia. Odds ratio of the HIV/AIDS-associated diseases developing a specific histopathological pattern was determined by logistic regression. RESULTS: A total of 197 men and 53 women were studied. The mean age was 36 years. Bacterial bronchopneumonia was present in 36% (91 cases) and Pneumocystis jiroveci pneumonia in 27% (68) of patients. Pulmonary histopathology showed acute interstitial pneumonia in 40% (99), diffuse alveolar damage in 36% (89), pulmonary edema in 13% (33), and alveolar hemorrhage in 12% (29) of patients. Multivariate analysis showed a significant and positive association between Pneumocystis jiroveci pneumonia and acute interstitial pneumonia (Odds ratio, 4.51; 95% CI, 2.46 -8.24; p < 0.001), severe sepsis and/or septic shock and diffuse alveolar damage (Odds ratio, 3.60; 95% CI, 1.78 -7.27; p < 0.001), and cytomegalovirus and acute interstitial pneumonia (Odds ratio, 2.22; 95% CI, 1.01 -4.93; p = 0.05). CONCLUSIONS: This report is the first autopsy study to include demographic data, etiologic diagnosis, and respective histopathological findings in patients with HIV/AIDS and acute respiratory failure. Further studies are necessary to elucidate the complete pulmonary physiopathological mechanism involved with each HIV/AIDS-associated disease.

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Section: Discussionmentioning

confidence: 99%

Post-Mortem Histological Pulmonary Analysis in Patients with HIV/AIDS

Soeiro

Hovnanian

Parra

et al. 2008

Clinics

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“…Autopsy remains the gold standard for confirming the cause of death. Previous studies have shown that (partial) autopsy is a feasible procedure in Sub-Saharan Africa, both in study settings and as a general practice [5], [6], [7].…”

Section: Introductionmentioning

confidence: 99%

An Autopsy Study Describing Causes of Death and Comparing Clinico-Pathological Findings among Hospitalized Patients in Kampala, Uganda

Cox

Lukande

Nelson³

et al. 2012

PLoS ONE

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BackgroundInformation on causes of death in HIV-infected patients in Sub-Saharan Africa is mainly derived from observational cohort and verbal autopsy studies. Autopsy is the gold standard to ascertain cause of death. We conducted an autopsy study to describe and compare the clinical and autopsy causes of death and contributory findings in hospitalized HIV-infected and HIV-uninfected patients in Uganda.MethodsBetween May and September 2009 a complete autopsy was performed on patients that died on a combined infectious diseases gastroenterology ward in Mulago Hospital in Kampala, Uganda. Autopsy cause of death and contributing findings were based on the macro- and microscopic post-mortem findings combined with clinical information. Clinical diagnoses were reported by the ward doctor and classified as confirmed, highly suspected, considered or not considered, based on information derived from the medical chart. Results are reported according to HIV serostatus.ResultsFifty-three complete autopsies were performed in 66% HIV-positive, 21% HIV-negative and 13% patients with an unknown HIV serological status. Infectious diseases caused death in 83% of HIV-positive patients, with disseminated TB as the main diagnosis causing 37% of deaths. The spectrum of illness and causes of death were substantially different between HIV-positive and HIV-negative patients. In HIV-positive patients 12% of postmortem diagnoses were clinically confirmed, 27% highly suspected, 16% considered and 45% not considered. In HIV-negative patients 17% of postmortem diagnoses were clinically highly suspected, 42% considered and 42% not considered.ConclusionAutopsy examination remains an important tool to ascertain causes of death particularly in settings with limited access to diagnostic testing during life. HIV-positive patients continue to die from treatable and clinically undiagnosed infectious diseases. Until rapid-point of care testing is available to confirm common infections, empiric treatment should be further investigated.

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“…Pulmonary tuberculosis was found in 17.8% of the cases in the whole period of our study. Autopsy studies have found the presence of Mycobacterium tuberculosis infection in 5% -59% of cases [33][34][35][36][37][38]. Worldwide is known the importance of mycobacterial tuberculosis coinfection in HIV positive patients.…”

Section: Discussionmentioning

confidence: 99%

“…Worldwide is known the importance of mycobacterial tuberculosis coinfection in HIV positive patients. In developed countries, the prevalence of tuberculosis in autopsies of patients with HIV/AIDS is much lower than developing countries, like Brazil [33][34][35][36][37][38]. CMV pneumonitis was found in 21.1% of patients.…”

Section: Discussionmentioning

confidence: 99%

Histopathological Analysis about Autopsies from HIV/AIDS Patients—About Two Decades of Research Comparing Results before and after Antiretroviral Therapy Advent

Ruppert¹,

Soeiro²,

Almeida³

et al. 2013

WJA

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Objectives: This study considers 489 autopsies of HIV/AIDS patients who died from acute respiratory failure and describes the demographic data, etiology, and histological pulmonary findings of HIV associated diseases, comparing results before and after introduction of antiretroviral therapy. Methods: The following data were obtained: age, sex, and major associated diseases (found at the autopsy). Pulmonary histopathology was categorized as: diffuse alveolar damage; pulmonary edema; alveolar hemorrhage; and acute interstitial pneumonia. Odds ratio of the HIV/AIDS-associated diseases developing a specific histopathological pattern was determined by logistic regression. Results: A total of 355 men were studied. The mean age was 37 years old. Bronchopneumonia presented in 43% and Pneumocystis jiroveci pneumonia in 38% of patients. Pulmonary histopathology showed diffuse alveolar damage in 31% and acute interstitial pneumonia in 23%. The multivariate analysis showed a significant and positive association between diffuse alveolar damage with disseminated tuberculosis, cirrhosis and sepsis; and acute interstitial pneumonia with Pneumocystis jiroveci pneumonia and cytomegalovirosis. After the introduction of antiretroviral therapy we observed an increase in the prevalence of bacterial bronchopneumonia, sepsis and cirrhosis; and a decrease in Pneumocystis jiroveci pneumonia and cytomegalovirosis. Conclusions: Coherent to literature, this study showed a decrease of respiratory failure mortality associated with some opportunistic infections after antiretroviral therapy introduction. But an increased prevalence of sepsis, bronchopneumonia and sepsis was observed too. The most prevalent pulmonary histopathological pattern was diffuse alveolar damage, which suggested a positive association with disseminated tuberculosis, sepsis and cirrhosis.

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The post-mortem pathology of HIV-1-infected African children

Cited by 18 publications

References 24 publications

Post-Mortem Histological Pulmonary Analysis in Patients with HIV/AIDS

Post-Mortem Histological Pulmonary Analysis in Patients with HIV/AIDS

An Autopsy Study Describing Causes of Death and Comparing Clinico-Pathological Findings among Hospitalized Patients in Kampala, Uganda

Histopathological Analysis about Autopsies from HIV/AIDS Patients—About Two Decades of Research Comparing Results before and after Antiretroviral Therapy Advent

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