HIV and Mortality, Autopsy Studies from Uganda


HIV can be treated nowadays; with antiretroviral medication HIV‐infected patients can live a healthy life. Nevertheless, 1.2 million people died of HIV in sub‐Saharan Africa in 2012. Better knowledge of the causes of death in these patients and of accurate methods to establish the causes of death can improve HIV‐care for the living.

Autopsy studies showed that opportunistic infections caused the vast majority of deaths, both prior to the availability of HIV‐treatment and afterwards. Tuberculosis was the main cause of death. In time, HIV‐treatment has become better available and we observed an increase in the proportion of patients that died of conditions that were not directly HIV‐related. This change will affect future HIV‐care in sub‐Saharan Africa.

The gold standard to ascertain the cause of death is a complete autopsy. We found that the autopsy cause of death was established pre‐mortem in only 12% of  hospitalized HIV‐patients. This implies that the clinical diagnosis lacks accuracy. However, complete autopsies are not always feasible, acceptable or safe. Therefore we studied an alternative method, needle autopsy, in which we obtained tissue postmortem by percutaneous biopsy. Needle autopsy identified the cause of death in half of the patients. Moreover, it appeared easy and fast to perform.

We concluded that the majority of HIV‐infected patients in sub‐Saharan Africa continues to die from treatable, undiagnosed infections. Needle autopsies can be an accurate, feasible and safe alternative for complete autopsies.