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Value of limited necropsy in HIV-positive patients
1Department of Anatomic Pathology, Hospital Txagorritxu, Vitoria-Gasteiz, Alava, Spain. iguerra@htxa.osakidetza.net
Abstract:
We performed limited autopsy with histological examination of tissue cores obtained percutaneously using the Tru-Cut needle and the Jamshidi trocar in 150 adult HIV-positive patients. Data were compared retrospectively with the antemortem clinical diagnosis. Eighty-one percent of the patients were male, and 78% were intravenous drug users. Specimens were obtained from the brain, liver, lung, bone marrow, and kidney of most patients. The main findings included liver cirrhosis in 22 cases (associated with HCV infection in 81%), Pneumocystis carinii pneumonia in 21, Cytomegalovirus (CMV) infection in 19, Mycobacterium avium-intracellulaire (MAI) infection in 17, bacterial pneumonia in 14, tuberculosis in 12, and lymphoma in 13 cases. Forty-six (30.6%) patients had at least one clinical diagnosis that was confirmed by autopsy, i.e., there was 40.6% agreement between pre- and postmortem findings. Forty-six (30.6%) patients had at least one clinical diagnosis that was not confirmed at autopsy, whereas 41 (27.3%) had at least one AIDS-related or unrelated disease that was not suspected clinically. The results obtained by limited autopsy are principally comparable to those achieved by full necropsy, with the advantages of decreasing the contagious risk, saving cost and time, including a rapid final diagnosis, and easily obtaining the consent for postmortem examination so that necropsy studies may be performed on a larger number of patients, thus contributing to a better understanding of the spectrum of HIV infection in our environment.
Insights
Limited autopsies in 150 HIV-positive patients revealed significant discrepancies between clinical diagnoses and autopsy findings. This method offers a cost-effective, rapid, and safe alternative to full necropsy for understanding HIV-related diseases.
Area of Science:
- Medical Pathology
- Infectious Diseases
- HIV/AIDS Research
Background:
- HIV-positive individuals often present with complex comorbidities.
- Accurate postmortem diagnosis is crucial for understanding disease progression and improving patient care.
- Traditional full necropsy can be resource-intensive and pose infection risks.
Purpose of the Study:
- To evaluate the efficacy of limited autopsy using percutaneous tissue sampling in HIV-positive patients.
- To compare autopsy findings with antemortem clinical diagnoses.
- To assess the benefits of limited autopsy in terms of cost, time, and diagnostic accuracy.
Main Methods:
- Histological examination of tissue cores from brain, liver, lung, bone marrow, and kidney.
- Percutaneous sampling using Tru-Cut needles and Jamshidi trocars.
- Retrospective comparison of autopsy results with clinical data in 150 adult HIV-positive patients.
Main Results:
- High prevalence of liver cirrhosis (22%), Pneumocystis pneumonia (21%), Cytomegalovirus (19%), Mycobacterium avium-intracellulaire (17%), bacterial pneumonia (14%), tuberculosis (12%), and lymphoma (13%).
- Only 40.6% agreement between clinical diagnoses and autopsy findings.
- 30.6% of clinical diagnoses were unconfirmed, and 27.3% of diseases were clinically unsuspected.
Conclusions:
- Limited autopsy provides diagnostic results comparable to full necropsy in HIV-positive patients.
- This method reduces contagious risks, saves costs and time, and facilitates rapid diagnosis.
- Limited autopsy enables larger-scale studies, enhancing understanding of the HIV disease spectrum.