COMPARISON OF CHANGING AUTOPSY TRENDS IN THE BRONX POPULATION WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

The opportunistic infections, malignancies, and causes of death relate d to acquired immunodeficiency syndrome (AIDS) are changing, perhaps a s a result of improved treatment, prophylaxis, and education. With its high percentage of persons who acquired the human immunodeficiency vi rus from intravenous drug (IVD) use, the population of patients with A IDS in the Bronx is potentially unique, All of the 257 consecutive adu lt human immunodeficiency virus and/or AIDS cases from two Bronx teach ing hospitals from 1982 through 1995 were collected, The reports were reviewed for patient demographics, opportunistic infections, malignanc ies, and causes of death. One hundred thirteen cases from 1982 through 1988 were compared with 144 cases from 1989 through 1995, separated b y the institution of antiretroviral therapy and Pneumocystis carinii ( PCP) prophylaxis in the latter period, Male homosexuality as a risk fa ctor significantly decreased from 24.8% of the cases in our study from the 1982/88 period to 12.5% during the 1989/95 period (P = 0.014), bu t IVD use cases showed no change. Cases of AIDS in heterosexual patien ts increased from 23.9 to 36.1% (P = 0.041) but did not achieve statis tical significance unless the unknown risk category (a population show n to be infected predominantly through heterosexual transmission) was included, The prevalence of PCP at autopsy as an opportunistic infecti on decreased from 37.2 to 25% (P = 0.04), and its prevalence as a caus e of death decreased from 31.9 to 13.9% (P = 0.007). This decrease was seen in the homosexual and heterosexual populations but not in the po pulation of IVD users, The homosexual population, as opposed to the po pulation of IVD users, may have taken greater advantage of PCP treatme nt and prevention, As a result, bronchopneumonia, not PCP, is now the leading cause of death among the patients with AIDS in this study, The se findings have important implications for therapy and prophylaxis to control the spread of AIDS and its related infections, particularly i n an inner city population troubled by drug use and poverty.