Document 0177
 DOCN  M94A0177
 TI    Evolving trends revealed by autopsies of patients with the acquired
       immunodeficiency syndrome. 565 autopsies in adults with the acquired
       immunodeficiency syndrome, Los Angeles, Calif, 1992-1993.
 DT    9412
 AU    Klatt EC; Nichols L; Noguchi TT; Department of Pathology, University of
       Utah Health Sciences; Center, Salt Lake City.
 SO    Arch Pathol Lab Med. 1994 Sep;118(9):884-90. Unique Identifier :
       AIDSLINE MED/94361597
 AB    OBJECTIVE. To determine changes in causes of death, survival, and organ
       system distribution of major opportunistic infections and neoplasms in
       adults dying with the acquired immunodeficiency syndrome (AIDS)
       following the widespread use of antiretroviral therapy and prophylaxis
       for opportunistic infections since 1988. DESIGN. A retrospective review
       of autopsy records with gross and microscopic pathologic findings,
       laboratory data, and clinical histories in cases of AIDS, comparing
       findings from 1982 through 1988 with those from 1989 through May 1993.
       SETTING. All autopsies were performed on persons dying in the
       metropolitan Los Angeles, Calif, area from January 1982 through May
       1993. RESULTS. In 565 adult cases of AIDS at autopsy, Pneumocystis
       carinii pneumonia (PCP) remained the most common cause of death, but
       both the frequency of and number of deaths of PCP declined over time.
       Deaths from bacterial sepsis, cytomegalovirus infection, Mycobacterium
       avium complex infection, and toxoplasmosis also declined during this
       period, but mortality from fungal infections, tuberculosis,
       encephalopathy, and causes unrelated to AIDS increased. The death rate
       from malignant lymphoma remained high. Kaposi's sarcoma (KS) continued
       to occur more frequently in patients whose risk factor for human
       immunodeficiency virus infection (HIV) was homosexuality or bisexuality,
       but the death rate from KS was greatest for patients with a risk factor
       of blood exposure to HIV. Survival was shorter and deaths from
       tuberculosis more common in patients with a history of intravenous drug
       use. Overall survival of patients in other AIDS risk groups increased
       over time, particularly in those treated with antiretroviral therapy.
       The organ system distribution of major opportunistic infections and
       neoplasms was similar throughout the years of the study. The lung was
       the most frequent organ involved by AIDS-associated diseases leading to
       death, followed by the gastrointestinal tract and the central nervous
       system. CONCLUSIONS. The causes of death in AIDS have evolved since 1988
       following the widespread use of prophylactic and antiretroviral
       therapies in patients with HIV infection. This has occurred primarily
       from changes in overall frequency and death rates from infections. Organ
       system involvement by AIDS-associated diseases has not changed
       significantly over time.
 DE    Acquired Immunodeficiency Syndrome/COMPLICATIONS/DRUG THERAPY/
       *MORTALITY  Adult  AIDS Dementia Complex/COMPLICATIONS/MORTALITY
       AIDS-Related Opportunistic Infections/COMPLICATIONS/DRUG THERAPY/
       *MORTALITY  Bisexuality  Cause of Death  Dideoxynucleosides/THERAPEUTIC
       USE  Drug Therapy, Combination  Female  Homosexuality  Human  Los
       Angeles/EPIDEMIOLOGY  Male  Middle Age  Neoplasms/COMPLICATIONS/DRUG
       THERAPY/*MORTALITY  Retrospective Studies  Risk Factors  Substance
       Abuse, Intravenous  Zidovudine/THERAPEUTIC USE  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).