Causes of death and autopsy findings in patients of the swiss HIV Cohort Study

The Swiss HIV Cohort Study (SHCS) is a prospective cohort study of HIV-infe cted adolescents and adults seen at 7 outpatient clinics (Swiss University Hospitals in Basle, Berne, Geneva, Lausanne, Zurich, the St. Gall Cantonal Hospital and the Civico Hospital in Lugano). The SHCS serves as an infrastr ucture for different research projects and includes about 70% of all patien ts with advanced disease in Switzerland. From April 1984 to November 1995 3 120 HIV-infected patients of the SHCS died. Autopsies were performed in 314 of these patients. The aim of our study is to analyse autopsy findings as well as causes of death in those 314 HIV-infected patients. An HIV-related cause of death was found in 271 (86%) of the patients, 12 pa tients (4%) died of a drug overdose, and 3 (1%) of the patients committed s uicide. 28 (9%) died either from an HIV-unrelared or unidentified cause. Th e five most frequent causes of death were: bacterial pneumonia (52 patients , 17%), Pneumocystis carinii pneumonia (40 patients, 13%), lymphoma (34 pat ients, 11%), cytomegalovirus infection (33 patients, 11%), and toxoplasmosi s (30 patients, 10%). During our study marked progress occurred in treating HIV-infected patients and preventing opportunistic infections. These improvements have further c hanged the natural course of acquired immunodeficiency syndrome. They are r eflected in the falling rare of Pneumocystis carinii pneumonia and toxoplas mosis, as well as an increase in lymphoma as a cause of death over the peri od of our study.