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HIV-related deaths outside medical institutions in Stockholm
1Department of Forensic Medicine, Karolinska Institutet, Stockholm, Sweden.
Insights
This study investigated Human Immunodeficiency Virus (HIV) in medico-legal autopsies over three years. HIV-positive drug addicts were found to have a higher risk of sudden death from heroin use compared to HIV-negative addicts.
Area of Science:
- Forensic Medicine
- Infectious Diseases
- Toxicology
Background:
- Systematic investigation of Human Immunodeficiency Virus (HIV) infection prevalence in medico-legal autopsy cases in Stockholm, Sweden.
- Data collected over a 3-year period (August 1, 1985 - July 31, 1988).
- Focus on identifying HIV antibodies in deceased individuals.
Purpose of the Study:
- To determine the prevalence of HIV infection in autopsy cases.
- To analyze the demographics and causes of death in HIV-positive individuals.
- To compare causes of death between HIV-positive and HIV-negative drug addicts.
Main Methods:
- Blood samples collected from femoral or subclavian veins prior to autopsy.
- ELISA-screening and Western blotting tests used for HIV antibody detection.
- Medico-legal autopsy case data analyzed.
Main Results:
- HIV infection detected in 0.32% to 0.83% of cases annually.
- 41 out of 53 HIV-positive cases were drug addicts; 8 were homosexual/bisexual males.
- HIV-positive drug addicts showed a higher tendency for sudden death related to intravenous heroin use compared to HIV-negative addicts.
Conclusions:
- HIV prevalence in medico-legal autopsies varied annually, with a peak in the second year.
- Drug addiction was the predominant risk factor for HIV infection in this cohort.
- HIV-positive drug addicts faced increased mortality risk from sudden death associated with heroin administration.
Abstract:
During a 3-year period (August 1st, 1985 to July 31st, 1988) a systematic investigation of medico-legal autopsy cases with regard to the presence of antibodies for HIV-virus was carried out at the Department of Forensic Medicine in Stockholm, Sweden. Prior to autopsy, blood samples were taken from femoral or subclavian veins and were investigated by use of ELISA-screening and Western blotting test. During the first year of study, HIV infection was demonstrated in 11 out of 3464 deaths (0.32%), during the second year in 29 out of 3483 deaths (0.83%), and during the last year in 13 out of 3107 deaths (0.42%). It was shown that 48 out of the total of 53 HIV positive cases were previously registered, but information about the infection was available to the autopsist in only 27 cases. Drug addicts dominated 41 of 53 cases. There were only eight homo- and bisexual males, two non drug addict Central Africans and two persons who received blood transfusions. Eight of the 53 persons died of natural causes whereas 45 deaths were due to violence and drugs. The causes of death of the HIV positive drug addicts were compared to the causes of death of the HIV negative addicts. The HIV positive drug addicts tended to die suddenly in connection with the intravenous administration of heroin and at lower blood concentrations of morphine more often than the HIV-negative addicts. No increase in the suicide frequency was noted in drug addicts in Stockholm during the studied period.