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Causes of death on antiretroviral therapy: a post-mortem study from South Africa.

Publication ,  Journal Article
Wong, EB; Omar, T; Setlhako, GJ; Osih, R; Feldman, C; Murdoch, DM; Martinson, NA; Bangsberg, DR; Venter, WDF
Published in: PLoS One
2012

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.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2012

Volume

7

Issue

10

Start / End Page

e47542

Location

United States

Related Subject Headings

  • Tuberculosis, Pulmonary
  • South Africa
  • Skin
  • Mycobacterium tuberculosis
  • Middle Aged
  • Male
  • Lymph Nodes
  • Lung
  • Liver
  • Kidney
 

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Wong, E. B., Omar, T., Setlhako, G. J., Osih, R., Feldman, C., Murdoch, D. M., … Venter, W. D. F. (2012). Causes of death on antiretroviral therapy: a post-mortem study from South Africa. PLoS One, 7(10), e47542. https://doi.org/10.1371/journal.pone.0047542
Wong, Emily B., Tanvier Omar, Gosetsemang J. Setlhako, Regina Osih, Charles Feldman, David M. Murdoch, Neil A. Martinson, David R. Bangsberg, and W. D. F. Venter. “Causes of death on antiretroviral therapy: a post-mortem study from South Africa.PLoS One 7, no. 10 (2012): e47542. https://doi.org/10.1371/journal.pone.0047542.
Wong EB, Omar T, Setlhako GJ, Osih R, Feldman C, Murdoch DM, et al. Causes of death on antiretroviral therapy: a post-mortem study from South Africa. PLoS One. 2012;7(10):e47542.
Wong, Emily B., et al. “Causes of death on antiretroviral therapy: a post-mortem study from South Africa.PLoS One, vol. 7, no. 10, 2012, p. e47542. Pubmed, doi:10.1371/journal.pone.0047542.
Wong EB, Omar T, Setlhako GJ, Osih R, Feldman C, Murdoch DM, Martinson NA, Bangsberg DR, Venter WDF. Causes of death on antiretroviral therapy: a post-mortem study from South Africa. PLoS One. 2012;7(10):e47542.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2012

Volume

7

Issue

10

Start / End Page

e47542

Location

United States

Related Subject Headings

  • Tuberculosis, Pulmonary
  • South Africa
  • Skin
  • Mycobacterium tuberculosis
  • Middle Aged
  • Male
  • Lymph Nodes
  • Lung
  • Liver
  • Kidney