Pathology and causes of death in a group of 128 predominantly HIV-positive patients in Botswana, 1997–1998
Abstract:BACKGROUND: Little is known about causes of death in countries of southern Africa seriously affected by the HIV/AIDS epidemic.
METHODS: After obtaining informed consent, autopsies were performed on 128 mainly hospitalised adults in Francistown, Botswana, between July 1997 and June 1998. Criteria for case selection included those who died before a diagnosis could be established, those whose condition deteriorated unexpectedly during hospitalization, and those who had respiratory disease. This represented 14% of adult medical patients who died in hospital during the study period.
RESULTS: Of the 128 patients, 104 (81%) were HIV-positive. Among HIV-positive patients, the most common pathologic findings were tuberculosis (TB) (40%), bacterial pneumonia (23%), Pneumocystis carinii pneumonia (11%), and KaposiÕs sarcoma (11%); these conditions were the cause of death in 38%, 14%, 11%, and 6%, respectively. Of the 40 pulmonary TB cases, 90% also had disseminated extra-pulmonary TB. Chest radiology could not reliably distinguish the pathologies pre-mortem.
CONCLUSIONS: TB was the leading cause of death in our series of HIV-positive adults in Botswana, selected towards those with chest disease; in most, it was widely disseminated. Bacterial pneumonia also played an important role in mortality. Pneumocystis carinii pneumonia was present, but relatively uncommon.
Document Type: Regular Paper
Affiliations: 1: The BOTUSA Project, Gaborone, Botswana and Department of Histopathology, Guy's, King's, & St. Thomas' School of Medicine, London, UK 2: Department of Pathology, Nyangabgwe Hospital, Francistown, Botswana 3: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: Department of Medicine, Nyangabgwe Hospital, Francistown, Botswana 5: The BOTUSA Project, Gaborone, Botswana and Department of Pathology, Nyangabgwe Hospital, Francistown, Botswana 6: Department of Histopathology, Guy's, King's, & St. Thomas' School of Medicine, London, UK
Publication date: January 1, 2002
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