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AIDS-defining diseases in 250 HIV-infected patients; a comparative study of clinical and autopsy diagnoses
A d'Arminio Monforte1, L Vago, A Lazzarin
1Clinic of Infectious Diseases, L. Sacco Hospital, University of Milan, Italy.
Objective:
To evaluate the correlation between clinical and autopsy findings in 250 AIDS patients.
Methods:
Clinical and autopsy diagnoses of AIDS-defining diseases in 250 AIDS patients who died in Milan between May 1984 and February 1991 were compared.
Results:
Pneumocystis carinii (PCP) and oesophageal candidiasis were the most frequent clinical diagnoses, while cytomegalovirus (CMV) infection was observed in almost half of the autopsies. Forty-seven per cent of the diseases found at autopsy had not been diagnosed during life; CMV infection, mycoses, HIV-specific brain lesions, cerebral lymphomas and progressive multifocal leukoencephalopathy (PML) had a higher rate of non-diagnosis in life. CMV visceral infection accounted for the majority of the diseases not recognized in life. In contrast, clinically diagnosed PCP, oesophageal candidiasis and, to a lesser degree, brain toxoplasmosis were often not found at autopsy, possibly indicating a significant rate of recovery and prevention of relapse. Finally, bacterial pneumonia and sepsis, although not AIDS indicator diseases, were observed in approximately one-third of the autopsies.
Conclusion:
Considerable differences in the frequency and type of the AIDS-defining diseases diagnosed during life and at post mortem were found.
Insights
Clinical and autopsy findings in AIDS patients show significant discrepancies in diagnosed diseases. Many autopsy-detected conditions, like cytomegalovirus (CMV) infection, were missed during life, impacting accurate AIDS diagnosis and care.
Area of Science:
- Medical research
- Infectious diseases
- Pathology
Background:
- Accurate diagnosis of Acquired Immunodeficiency Syndrome (AIDS)-defining diseases is crucial for patient management.
- Discrepancies between clinical diagnoses and autopsy findings can highlight diagnostic challenges and areas for improvement.
Purpose of the Study:
- To compare clinical diagnoses with autopsy findings in a cohort of 250 AIDS patients.
- To identify specific AIDS-defining diseases with significant differences between antemortem and postmortem evaluations.
Main Methods:
- Retrospective analysis of clinical records and autopsy reports from 250 AIDS patients.
- Comparison of diagnosed AIDS-defining diseases identified during life versus at autopsy.
Main Results:
- Cytomegalovirus (CMV) infection, mycoses, and certain neurological conditions (e.g., progressive multifocal leukoencephalopathy) were frequently missed in clinical diagnoses but found at autopsy.
- Pneumocystis carinii pneumonia (PCP) and oesophageal candidiasis, though common clinical diagnoses, were often not confirmed at autopsy, suggesting effective treatment or recovery.
- Bacterial pneumonia and sepsis were common comorbidities observed in autopsies, despite not being primary AIDS-defining illnesses.
Conclusions:
- Significant discordance exists between clinical and autopsy diagnoses of AIDS-related conditions.
- Underdiagnosis of opportunistic infections like CMV and neurological complications is a key issue.
- The findings underscore the need for improved diagnostic strategies and awareness of diverse manifestations in AIDS patients.