Autopsy study of HIV-1-positive and HIV-1-negative adult medical patients in Nairobi, Kenya

HIV infection has now been consistently identified as the major cause of de ath in young Africans in both urban and rural areas. In Africa, several stu dies have defined the clinical presentation of HIV disease but there have o nly been a limited number of autopsy studies. Because of the scarcity of au topsy data and the possibility of differing type and frequency of opportuni stic infections between different geographic locations we set out to study consecutive new adult medical admissions to a tertiary referral hospital in Nairobi and perform autopsies on a sample of HIV-1-positive and HIV-l-nega tive patients who died in the hospital ward. Basic demographic data were co llected on all patients admitted to two acute medical wards over an Ii-mont h period. Final outcome and final clinical diagnoses were recorded at disch arge or death. An autopsy examination was requested if the patient died in the ward. Autopsy examination was performed in 75 HN-l-positive (40 men, 35 women) and 47 HIV-1-negative (28 men, 19 women) adults who died in the hos pital. This represented 48.4% of all HIV-l-positive deaths and 33.3% of all HIV-l-negative deaths. Tuberculosis (TB) and bacterial and interstitial br onchopneumonia accounted for 96% of the major pathology in patients found t o be HN-l-positive at autopsy. TB was present in half the HIV-l-positive au topsy patients and was disseminated in over 80% of cases. Meningeal involve ment was present in 26% of those with disseminated TB, By contrast, TB was much less common in the HIV-1-negative patients at autopsy in whom bacteria l bronchopneumonia and malignancies were the most common pathologies. The t ype pathology found in the HIV-l-positive autopsy patients was not differen t than that found in other areas in Africa so far studied.