CLINICOPATHOLOGICAL STUDY OF CYTOMEGALOVIRUS (CMV) IN AIDS AUTOPSIES - UNDER-RECOGNITION OF CMV PNEUMONITIS AND CMV ADRENALITIS

Background: Cytomegalovirus (CMV) is a common cause of morbidity in hu man immunodeficiency virus (HIV) infected patients, predominantly when severe immunosuppression has occurred. Although CMV infection of the retina and gastrointestinal tract is well recognised as causing substa ntial morbidity, the significance of infection at other sites, in part icular the lungs and adrenal glands is unclear. Aims: To assess the ex tent of CMV infection in postmortem examinations performed on HIV-infe cted patients. To estimate the degree of concordance between clinical and postmortem findings and the effect of prior diagnosis and/or treat ment of CMV infection. Methods: The postmortem examination findings an d clinical records of 25 consecutive HIV-infected patients who underwe nt a complete autopsy were examined. Results: CMV infection was demons trated in 19 patients (76%) at postmortem examination, with the most c ommon sites of infection being the adrenal glands (56%) and lungs (44% ). Concordance between clinical diagnosis of CMV infection and postmor tem findings was low with only five of 19 patients (26%) having an ant emortem diagnosis. No patient with CMV infection of the lungs or adren al glands had a clinical diagnosis made, despite four patients having florid CMV pneumonitis at postmortem examination; in three the probabl e cause of death. Conclusion: CMV infection is a common postmortem fin ding in HIV-infected patients but the concordance between clinical dia gnosis and autopsy findings is low. CMV appears to be a significant pa thogen in HIV-related respiratory disease.