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Postmortem Investigations Following Human Immunodeficiency Virus Infection

Background: HIV/AIDS is a global disease and despite intensive research it is one of the main causes of human death. Postmortem studies have proven accurate in determining the various pathologies in these patients.

Aims & Objectives: Our aim was to analyze the post mortem results of individuals who died after HIV infection in the same geographical region. We evaluated the most frequent opportunistic diseases and their clinical and morphological outcomes.

Methods: We studied case reports and autopsy research data from 32 patients who died after HIV infection in Smolensk, Russian Federation, between 2003 and 2008. All patients had been diagnosed with HIV infection before death, using HIV-specific enzyme linked immunosorbent assay (ELISA) and immunoblotting. Autopsy specimens of various organs were examined histologically and microbiologically.
Findings: The mean survival period from the moment of detection of seropositivity in all the patients was less than fiveyears. Twelve patients had a parenteral mode of contact, six had been infected by sexual contact, and 14 patients had unknown modes of infection. Most patients (69%) had chronic hepatitis C. The main causes of death were various infectious diseases. The most common were generalized miliary tuberculosis and progressive secondary tuberculosis of the lungs. Three (9%) patients had tuberculosis of the meninges and five (16%) had peritoneal infections, but tuberculous peritonitis had not been diagnosed before death. Six patients had pulmonary tuberculosis and bacterial pneumonia simultaneously. Two (6%) patients died from bacterial sepsis as a result of cervical lymphadenitis, and eight (12.5%) from abscess-forming pneumonia. The opportunistic infections revealed were Pneumocystis carinii pneumonia (eight patients), cytomegaloviral pneumonia (three), bronchopulmonary aspergillosis (one) and mucosal candidiasis (three). In three patients, the causes of death were advanced neoplastic processes: two cases of leukemia and one case of cervical cancer. Conclusions: Tuberculosis was the most widespread among the opportunistic infections, which often had affected the entire lung and had a destructive form. In the morphological picture of tuberculous inflammation, alterative and exudative changes dominated. Moreover, HIV infection had a characteristically broad spectrum of causative agents of pneumonia, including bacteria, viruses, fungi, and protozoa.

Author(s): Dr. Andrey V. Bychkov (MD),Prof. Alexander E. Dorosevich (MD, PhD., D.Sci.),Jimson W. D'souza

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