International Journal of STD & AIDS > Volume 20, Number 2 > Pp. 84-86

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Original research articles

Autopsies in HIV: still identifying missed diagnoses

M B J Beadsworth MRCP DTMH ^* , D Cohen MRCP ^*, L Ratcliffe MRCP ^*, N Jenkins PhD MRCP ^*, W Taylor FRCPath , F Campbell FRCPath , N J Beeching FRCP DTMH ^* and B Azadeh FRCPath 

^* Tropical and Infectious Disease Unit, Royal Liverpool University Hospital; Department of Histopathology, University Hospital Aintree; Department of Histopathology, Royal Liverpool University Hospital, Liverpool, UK

Correspondence to: Dr Mike Beadsworth Email: mikebeadsworth{at}yahoo.com

This study reviews the deaths and autopsies carried out over 23 years, 1983–2005, in a British Infection Unit in HIV patients. Of 115 HIV patients known to have died, we obtained data on 93%. Of this 80% were male, median age 38 (25–68) years; 83% were Caucasian; 12% Black African. Major risk factors were men who have sex with men, 52%; heterosexual in Africa, 17%; and injecting drug use, 8%. The commonest diagnosis pre- and post-autopsy diagnosis was pneumonia. Changes in diagnoses in the 38% who underwent autopsy were high (we requested autopsy in 50%). Primary diagnosis changed in 70%, and 36% of all opportunistic infections were missed. This included six of nine cytomegalovirus, all tuberculosis and 75% of Kaposi's sarcoma. Lymphoma was overdiagnosed. Thus, despite excellent resources, the majority of primary diagnoses were wrong, suggesting inadequacy of current diagnostics. To improve these and improve both epidemiological data and future management autopsy should be considered for all deaths.

Key Words: autopsy • post-mortem • HIV • AIDS • diagnosis

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