Abstract
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.
Highlights
The roll-out of antiretroviral therapy (ART) in 2004 has decreased mortality among the HIV-infected, HIV mortality rates in Sub-Saharan Africa remain high
Previous studies have shown that autopsy is a feasible procedure in Sub-Saharan Africa, both in study settings and as a general practice [5,6,7]
In this paper we present the autopsy data of 53 patients; 66% HIV-positive, 21% HIV-negative and 13% patients with an unknown serological status
Summary
The roll-out of antiretroviral therapy (ART) in 2004 has decreased mortality among the HIV-infected, HIV mortality rates in Sub-Saharan Africa remain high. In Uganda, an estimated 1.1 million people were HIV-infected and 61.000 deaths were caused by HIV-related illness in 2008 [2]. Due to limited diagnostic testing in most sub-Saharan African countries, the exact cause of death is often difficult to ascertain. Autopsy remains the gold standard for confirming the cause of death. Information 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.
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