AUTOPSY-PROVEN CAUSES OF DEATH IN HIV-INFECTED PATIENTS TREATED FOR TUBERCULOSIS IN ABIDJAN, COTE-DIVOIRE

Objective: To determine autopsy-proven causes of death in HIV-infected patients treated for tuberculosis in Abidjan, Cote d'lvoire. Methods: A computerized listing of 9523 patients diagnosed with tuberculosis a nd tested for HIV infection at Abidjan's two large tuberculosis treatm ent centers from July 1989 to December 1991 was matched against a list ing of 496 patients who were autopsied in Abidjan's largest public hos pital in 1991-1992. Results: Fifteen matching patients were identified including 11 adults with smear-positive pulmonary tuberculosis, three adults with extrapulmonary tuberculosis, and one child with smear-neg ative pulmonary tuberculosis. The autopsy-proven causes of death among the adults were tuberculosis (n = 4), bacterial infections (n = 3), c erebral toxoplasmosis (n = 2), pulmonary nocardiosis (n = 2), Pneumacy stis carinii pneumonia (n = 1), atypical mycobacteriosis (n = 1), and wasting syndrome (n = 1). Tuberculosis was the primary cause of death in two of five smear-positive patients who had not completed therapy, in none of the six patients with smear-positive disease who had comple ted therapy, and in two of the three patients with extrapulmonary tube rculosis. Conclusions: Chemoprophylaxis with trimethoprim-sulfamethoxa zole (TMP-SMX) might have provided benefit to eight (57%) of the 14 ad ults in this series who died either of bacterial infections, toxoplasm osis, nocardiosis, or pneumocystosis. Prospective studies are required to elucidate further the causes of increased mortality, and to evalua te the benefits of TMP-SMX prophylaxis in HIV-infected African patient s with tuberculosis.