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Autopsy findings on patients with AIDS in Taiwan
C H Hsiao1, S H Huang, S F Huang
1Department of Pathology, National Taiwan University Hospital, Taipei.
Abstract:
At National Taiwan University Hospital, from 1986 to 1996, autopsies were performed on 16 patients with acquired immunodeficiency syndrome. There were 15 men and 1 woman. Fourteen of these male patients had contracted the disease as a result of sexual practice, among which 9 were homosexual, 1 was bisexual and 4 were heterosexual. One of the patients had become infected by sharing a syringe during intravenous drug use. The female was a sex worker. Among these patients, only 2 had been tested for HIV before developing AIDS. On autopsy, lymphoid depletion and thymus atrophy were found in all patients. Testicular atrophy was noted in all the male patients. Three patients died of malignant lymphoma. Twelve patients died of opportunistic infections and 1 committed suicide. The initial opportunistic infection was usually oral candidiasis. Pneumocystis carinii pneumonia (PCP) was the most common opportunistic infection developed in the early stage while cytomegalovirus (CMV) infection was the most common one found in the late stage. Mycobacterium infection had developed in 8 patients. Six patients had disseminated Kaposi's sarcoma (KS) and 4 of them were homosexual. In 4 patients, biopsy specimens were proved to have KS associated viral (HHV-8) genome. Malignant lymphoma was found in 4 cases, all were of high grade B cell type. Epstein-Barr virus (EBV) encoding small RNA (EBER1) was demonstrated in all the lymphomas. In conclusion, (1) the prevalence of tuberculosis (38%) in patients with AIDS in Taiwan is high; (2) the most common opportunistic infections in this series are candidiasis, PCP and CMV infections; (3) the incidence of AIDS related non-Hodgkin's lymphoma in Taiwan has increased since 1995.
Insights
Autopsies of 16 patients with acquired immunodeficiency syndrome (AIDS) in Taiwan revealed high rates of tuberculosis and common opportunistic infections like candidiasis, Pneumocystis carinii pneumonia (PCP), and cytomegalovirus (CMV). The study also noted an increase in AIDS-related non-Hodgkin
Area of Science:
- Medical Pathology
- Infectious Diseases
- Oncology
Background:
- Acquired immunodeficiency syndrome (AIDS) is a complex condition with diverse clinical manifestations.
- Understanding the spectrum of opportunistic infections and malignancies in AIDS patients is crucial for clinical management and public health.
- Autopsy studies provide valuable insights into the pathological changes and causes of death in AIDS.
Purpose of the Study:
- To analyze the pathological findings and causes of death in a cohort of patients with acquired immunodeficiency syndrome (AIDS) in Taiwan.
- To determine the prevalence of opportunistic infections and malignancies in this patient group.
- To investigate the epidemiological characteristics of AIDS cases during the study period.
Main Methods:
- Retrospective autopsy analysis of 16 patients diagnosed with acquired immunodeficiency syndrome (AIDS) at National Taiwan University Hospital from 1986 to 1996.
- Review of clinical data, including mode of HIV transmission and pre-existing conditions.
- Pathological examination for lymphoid depletion, thymus atrophy, testicular atrophy, opportunistic infections, and malignancies.
Main Results:
- All patients exhibited lymphoid depletion and thymus atrophy; male patients showed testicular atrophy.
- The most common causes of death were opportunistic infections (12 patients) and malignant lymphoma (3 patients).
- Mycobacterium infection (38%), Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) infection, and Kaposi's sarcoma (KS) were prevalent opportunistic conditions.
- Epstein-Barr virus (EBV) was detected in all high-grade B-cell lymphomas.
Conclusions:
- Tuberculosis is highly prevalent in AIDS patients in Taiwan.
- Candidiasis, PCP, and CMV infections are the most frequent opportunistic infections.
- There has been an observed increase in AIDS-related non-Hodgkin's lymphoma incidence in Taiwan since 1995.