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M94A0177.TXT
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1994-10-08
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Document 0177
DOCN M94A0177
TI Evolving trends revealed by autopsies of patients with the acquired
immunodeficiency syndrome. 565 autopsies in adults with the acquired
immunodeficiency syndrome, Los Angeles, Calif, 1992-1993.
DT 9412
AU Klatt EC; Nichols L; Noguchi TT; Department of Pathology, University of
Utah Health Sciences; Center, Salt Lake City.
SO Arch Pathol Lab Med. 1994 Sep;118(9):884-90. Unique Identifier :
AIDSLINE MED/94361597
AB OBJECTIVE. To determine changes in causes of death, survival, and organ
system distribution of major opportunistic infections and neoplasms in
adults dying with the acquired immunodeficiency syndrome (AIDS)
following the widespread use of antiretroviral therapy and prophylaxis
for opportunistic infections since 1988. DESIGN. A retrospective review
of autopsy records with gross and microscopic pathologic findings,
laboratory data, and clinical histories in cases of AIDS, comparing
findings from 1982 through 1988 with those from 1989 through May 1993.
SETTING. All autopsies were performed on persons dying in the
metropolitan Los Angeles, Calif, area from January 1982 through May
1993. RESULTS. In 565 adult cases of AIDS at autopsy, Pneumocystis
carinii pneumonia (PCP) remained the most common cause of death, but
both the frequency of and number of deaths of PCP declined over time.
Deaths from bacterial sepsis, cytomegalovirus infection, Mycobacterium
avium complex infection, and toxoplasmosis also declined during this
period, but mortality from fungal infections, tuberculosis,
encephalopathy, and causes unrelated to AIDS increased. The death rate
from malignant lymphoma remained high. Kaposi's sarcoma (KS) continued
to occur more frequently in patients whose risk factor for human
immunodeficiency virus infection (HIV) was homosexuality or bisexuality,
but the death rate from KS was greatest for patients with a risk factor
of blood exposure to HIV. Survival was shorter and deaths from
tuberculosis more common in patients with a history of intravenous drug
use. Overall survival of patients in other AIDS risk groups increased
over time, particularly in those treated with antiretroviral therapy.
The organ system distribution of major opportunistic infections and
neoplasms was similar throughout the years of the study. The lung was
the most frequent organ involved by AIDS-associated diseases leading to
death, followed by the gastrointestinal tract and the central nervous
system. CONCLUSIONS. The causes of death in AIDS have evolved since 1988
following the widespread use of prophylactic and antiretroviral
therapies in patients with HIV infection. This has occurred primarily
from changes in overall frequency and death rates from infections. Organ
system involvement by AIDS-associated diseases has not changed
significantly over time.
DE Acquired Immunodeficiency Syndrome/COMPLICATIONS/DRUG THERAPY/
*MORTALITY Adult AIDS Dementia Complex/COMPLICATIONS/MORTALITY
AIDS-Related Opportunistic Infections/COMPLICATIONS/DRUG THERAPY/
*MORTALITY Bisexuality Cause of Death Dideoxynucleosides/THERAPEUTIC
USE Drug Therapy, Combination Female Homosexuality Human Los
Angeles/EPIDEMIOLOGY Male Middle Age Neoplasms/COMPLICATIONS/DRUG
THERAPY/*MORTALITY Retrospective Studies Risk Factors Substance
Abuse, Intravenous Zidovudine/THERAPEUTIC USE JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).