Causes of death in the HAART era

Compared with vast literature on the clinical, imaging, and in-vivo microbiology aspects of HIV disease, there is less on biopsy pathology and even less on autopsy data. This review focuses on some current clinico-pathological issues, with indications of where there is less certainty than we would like.

The most important change in causes of death in HIV disease, since the advent of highly active antiretroviral therapy (HAART), is the reduction of classical AIDS-defining opportunistic diseases, with the compensating increase in background comorbidities related to lifestyle, infections including the hepatitis viruses and HHV8, ageing, drug toxicity and immune reconstitution inflammatory syndrome phenomena. In low-income countries, HIV contributes significantly to maternal mortality.

To understand HIV disease better and manage future patients better, we need more tissue clinico-pathological correlation, including quality biopsy and autopsy evaluations.