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Yield of diagnostic tests for opportunistic infections in AIDS: a survey of 33 patients
P C Gøtzsche1, I C Bygbjerg, B Olesen
1Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
Abstract:
To examine the therapeutic consequences of diagnostic tests for AIDS-related infections, case records from 33 deceased AIDS patients were reviewed; 23 were autopsied. Determination of serum antibody titres was not important. In particular, there was no relation between titres and isolation of cytomegalovirus (CMV); isolation attempts or possibly antigen determination would be better. Samples for CMV isolation were obtained from 31 patients; only 7 were negative. Blood, faeces, and particularly sputum cultures gave a low yield; the number of such examinations could be reduced considerably. However, 4/7 disseminated infections with atypical mycobacteria were only revealed at autopsy, despite numerous cultures in vivo. Liver biopsies were not helpful. Diagnostic procedures for Pneumocystis carinii pneumonia by lung biopsy caused pneumothorax in 3/15 patients; bronchoalveolar lavage or treatment/prophylaxis without diagnosis could be considered. In 8 autopsies, microscopy was suggestive of cerebral toxoplasmosis, but only 1 patient had presented important clinical symptoms. We suggest a schedule with regular microbiologic and parasitic examinations and few antibody tests, but with more antigen tests.
Insights
Diagnostic tests for AIDS-related infections need improvement. Antibody tests were not useful; antigen tests and regular microbiologic/parasitic exams are recommended for better patient outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Diagnostic strategies for AIDS-related infections require evaluation for therapeutic impact.
- Autopsy findings in deceased AIDS patients offer insights into diagnostic test efficacy.
- Current diagnostic methods may not consistently identify opportunistic infections in advanced HIV disease.
Purpose of the Study:
- To assess the therapeutic consequences of diagnostic tests used in AIDS patients.
- To identify more effective diagnostic approaches for common AIDS-related infections.
- To optimize the utilization of laboratory investigations in managing HIV/AIDS.
Main Methods:
- Retrospective review of case records from 33 deceased AIDS patients, including 23 autopsies.
- Analysis of diagnostic test results, including serum antibody titres, viral isolation (CMV), and various cultures (blood, faeces, sputum, mycobacteria).
- Evaluation of tissue biopsies (liver, lung) and autopsy findings for diagnosing infections like Pneumocystis carinii pneumonia and cerebral toxoplasmosis.
Main Results:
- Serum antibody titres showed no correlation with cytomegalovirus (CMV) isolation; antigen detection or isolation attempts are preferred.
- Routine cultures (blood, faeces, sputum) yielded limited diagnostic information and could be reduced.
- Disseminated atypical mycobacterial infections were often detected only at autopsy, despite in vivo cultures. Lung biopsy for Pneumocystis carinii pneumonia carried risks (pneumothorax); bronchoalveolar lavage is a safer alternative. Cerebral toxoplasmosis was frequently subclinical.
- Liver biopsies were unhelpful for diagnosis.
Conclusions:
- Current antibody-based diagnostic tests for AIDS-related infections have limited therapeutic value.
- A revised diagnostic strategy emphasizing regular microbiologic and parasitic examinations, alongside increased antigen testing, is recommended.
- Reducing reliance on low-yield cultures and invasive procedures like lung biopsy can improve patient safety and diagnostic efficiency in AIDS care.