A CLINICOPATHOLOGICAL AUDIT OF OPPORTUNISTIC VIRAL-INFECTIONS IN HIV-INFECTED PATIENTS

Objective: To determine the prevalence of opportunistic viral infectio ns in multiple tissues at postmortems of HIV-infected patients, and to relate these findings to their antemortem clinical course. Design: A study of viral infections in 16 tissues of HIV-positive postmortem cas es, by a combination of histology and cell culture (virus isolation). Clinical details were abstracted retrospectively from patient records. Patients: Forty-seven consecutive autopsies, performed between 1985 a nd 1992. Setting: Autopsies were conducted by a single pathologist in a single London teaching hospital. Results: Opportunistic viral infect ions were detected in 72% of all cases, comprising cytomegalovirus (CM V, 66%), herpes simplex virus (11%), JC virus (6%) and adenovirus (2%) . The most commonly infected tissues were lung, adrenal, gastrointesti nal tract and central nervous system, although all tissue sites sample d could potentially support viral replication. Of 464 tissues tested b y both histology and cell culture, histology alone detected CMV in 45 tissues and cell culture alone detected CMV in 31 tissues. We determin ed that CMV detection in postmortem gastrointestinal tissues and centr al nervous tissue was significantly associated with antemortem undiagn osed diarrhoea and encephalitis, respectively. Conclusion: There is a high prevalence of opportunistic viral infections in late-stage HIV di sease, which is best detected postmortem by the use of both histology and cell culture. Many of these infections correlate with undiagnosed symptoms antemortem. The ability of sensitive methods for virus detect ion to alert the clinician to such cases antemortem should be critical ly evaluated, as should attempts to influence the natural history of t hese infections by antiviral drugs. Continuing clinico-pathological au dit is important for AIDS patients in order to monitor the impact of k nown opportunistic viral infections and to identify others which may e merge as immunosuppression becomes more profound.