Changing patterns of autopsy findings among persons with acquired immunodeficiency syndrome in an inner-city population. A 12-year retrospective study.

Abstract

To determine patterns of autopsy findings among persons with acquired immunodeficiency syndrome (AIDS) during a 12-year period. All 168 autopsies performed on adult AIDS patients at the Bronx-Lebanon Hospital Center in New York City between 1982 and 1993 were analyzed. The Center is a 725-bed, acute-care facility in the south Bronx, which serves a population of approximately half a million people. High poverty levels, tuberculosis and AIDS incidence, and intravenous drug abuse are common in this population. Subjects were predominantly Hispanic and black. Changes in the frequency of single and multiple opportunistic infections in general and frequencies of specific infections during the 12-year period. Through 1986, 75% of AIDS autopsies demonstrated single infections, particularly Pneumocystis carinii pneumonia. Since 1987, 72% of autopsies demonstrated multiple infections related to P carinii pneumonia, mycobacteriosis, cytomegalovirus, and various fungi. During the last 3 years, the prevalence of mycobacterial infections was higher than in the previous 9 years combined. In contrast, P carinii pneumonia decreased from 52% in 1988 to 14% in 1993. We note the recent emergence of multiple infections by multiple organisms, a significant decrease in the prevalence of P carinii pneumonia, and a slight increase in mycobacterial tuberculosis. Awareness of these changing patterns of infection may be useful in treating persons with AIDS.