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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Causes of Death on Antiretroviral Therapy: A Post-Mortem Study from South Africa
PLoS ONE, Volume 7, No. 10, Article e47542, Year 2012
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Description
Background: Mortality in the first months of antiretroviral therapy (ART) is a significant clinical problem in sub-Saharan Africa. To date, no post-mortem study has investigated the causes of mortality in these patients. Methods: HIV-positive adults who died as in-patients at a Johannesburg academic hospital underwent chart-review and ultrasound-guided needle autopsy for histological and microbiological examination of lung, liver, spleen, kidney, bone marrow, lymph node, skin and cerebrospinal fluid. A clinico-pathologic committee considered all available data and adjudicated immediate and contributing causes of death. Results Thirty-nine adults were enrolled: 14 pre-ART, 15 early-ART (7-90 days), and 10 late-ART (>90 days). Needle sampling yielded adequate specimen in 100% of kidney, skin, heart and cerebrospinal fluid samples, 97% of livers and lungs, 92% of bone marrows, 87% of spleens and 68% of lymph nodes. Mycobacterial infections were implicated in 69% of deaths (26 of 27 of these due to M. tuberculosis), bacterial infections in 33%, fungal infections in 21%, neoplasm in 26%, and non-infectious organ failure in 26%. Immune reconstitution inflammatory syndrome (IRIS) was implicated in 73% of early-ART deaths. Post-mortem investigations revealed previously undiagnosed causes of death in 49% of cases. Multiple pathologies were common with 62% of subjects with mycobacterial infection also having at least one other infectious or neoplastic cause of death. Conclusions: Needle biopsy was efficient and yielded excellent pathology. The large majority of deaths in all three groups were caused by M. tuberculosis suggesting an urgent need for improved diagnosis and expedited treatment prior to and throughout the course of antiretroviral therapy. Complex, unrecognized co-morbidities pose an additional challenge. © 2012 Wong et al.
Authors & Co-Authors
Wong, Emily B.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
United States, Boston
Massachusetts General Hospital
South Africa, Durban
University of Kwazulu-natal
Omar, Tanvier
South Africa, Johannesburg
School of Pathology
Setlhako, Gosetsemang J.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Osih, Regina B.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Feldman, Charles
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Murdoch, David M.
United States, Durham
Duke University Medical Center
Martinson, Neil Alexander
South Africa, Johannesburg
University of the Witwatersrand
United States, Baltimore
Johns Hopkins School of Medicine
Bangsberg, David R.
United States, Cambridge
Massachusetts Institute of Technology
Venter, Willem Daniel François
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Statistics
Citations: 141
Authors: 9
Affiliations: 8
Identifiers
Doi:
10.1371/journal.pone.0047542
e-ISSN:
19326203
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Study Locations
South Africa