Pattern of diseases in human immunodeficiency virus/AIDS patients in Lagos University Teaching Hospital: A 1-year prospective autopsy study

Abstract

Background and Objective: Nigeria has the second largest number of individuals living with human immunodeficiency virus/AIDS (HIV/AIDS) in the world after South Africa and contributes about 9% of the global HIV burden. It has also been estimated that there are 336,379 annual new HIV infections and about 192,000 of these individuals die of HIV/AIDS annually in Nigeria. Yet, there is a paucity of autopsy data among HIV/AIDS deaths in Nigeria. The objective of this study was to describe autopsy findings in HIV/AIDS cases in Lagos University Teaching Hospital (LUTH), a tertiary health center in Southwest Nigeria, which has one of the highest autopsy rates in the country. Materials and Methods: This 1-year prospective descriptive study included all HIV-1- and HIV-2-positive cases referred for autopsy examination at the Anatomic and Molecular Pathology Department of LUTH, Lagos, Nigeria. The study population included HIV-positive cases of all ages and sex. Results: Seven hundred and fifty-four autopsies were performed over the study period giving an autopsy rate of 33.1%. Forty-four patients (21 males and 23 females) were found to be HIV positive representing a prevalence of 5.8%. Of these, 23 (53.3%) cases were diagnosed antemortem, while 21 (47.7%) were diagnosed in the autopsy room. The patients' age ranged from 6 h to 69 years with a median age of 34 years. Infections were seen in 27 (61.4%) cases, out of which 13 (48.1%) were AIDS defining infections: 8 (18.2%) of them had tuberculosis, 2 (4.5%) cases of nontuberculous bacterial pneumonia, 1 (2.3%) case each of cryptococcosis, Pneumocystis jiroveci pneumonia, and progressive multifocal leukoencephalopathy (2.3%). Two (4.5%) patients had neoplasms (one case each of non-Hodgkin lymphoma and pleomorphic sarcoma). Miscellaneous causes of death included hypertensive heart disease, perforated strangulated right inguinal hernia, perforated ileoileal intussusceptions, and penetrating perineal injury. Conclusion: This study showed a demographic pattern of HIV infection comparable with previous national surveillance data, but a higher HIV seroprevalence than the most recent national surveillance data. Opportunistic infections were the most common cause of mortality in HIV infection and about half of HIV infected persons presented to the autopsy room undiagnosed.