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

Objective.-To determine changes in causes of death, survival, and orga n system distribution of major opportunistic infections and neoplasms in adults dying with the acquired immunodeficiency syndrome (AIDS) fol lowing the widespread use of antiretroviral therapy and prophylaxis fo r opportunistic infections since 1988. Design.-A retrospective review of autopsy records with gross and microscopic pathologic findings, lab oratory data, and clinical histories in cases of AIDS, comparing findi ngs from 1982 through 1988 with those from 1989 through May 1993. Sett ing.-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 bacter ial sepsis, cytomegalovirus infection, Mycobacterium avium complex inf ection, and toxoplasmosis also declined during this period, but mortal ity from fungal infections, tuberculosis, encephalopathy, and causes u nrelated to AIDS increased. The death rate from malignant lymphoma rem ained high. Kaposi's sarcoma (KS) continued to occur more frequently i n patients whose risk factor for human immunodeficiency virus infectio n (HIV) was homosexuality or bisexuality, but the death rate from KS w as greatest for patients with a risk factor of blood exposure to HIV, Survival was shorter and deaths from tuberculosis more common in patie nts with a history of intravenous drug use. Overall survival of patien ts in other AIDS risk groups increased over time, particularly in thos e treated with antiretroviral therapy. The organ system distribution o f 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 gastroin testinal 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 inf ection. This has occurred primarily from changes in overall frequency and death rates from infections. Organ system involvement by AIDS-asso ciated diseases has not changed significantly over time.