Opportunistic Infections in HIV-Infected Patients Differ Strongly in Frequencies and Spectra between Patients with Low CD4+ Cell Counts Examined Postmortem and Compensated Patients Examined Antemortem Irrespective of the HAART Era.
OBJECTIVE
AIDS-related mortality has changed dramatically with the onset of highly active antiretroviral therapy (HAART), which has even allowed compensated HIV-infected patients to withdraw from secondary therapy directed against opportunistic pathogens. However, in recently autopsied HIV-infected patients, we observed that associations with a broad spectrum of pathogens remain, although detailed analyses are lacking. Therefore, we focused on the possible frequency and spectrum shifts in pathogens associated with autopsied HIV-infected patients.


METHODS
We hypothesized that the pathogens frequency and spectrum changes found in HIV-infected patients examined postmortem did not recapitulate the changes found previously in HIV-infected patients examined antemortem in both the pre- and post-HAART eras. Because this is the first comprehensive study originating from Central and Eastern Europe, we also compared our data with those obtained in the West and Southwest Europe, USA and Latin America.


METHODS
We performed autopsies on 124 HIV-infected patients who died from AIDS or other co-morbidities in the Czech Republic between 1985 and 2014. The pathological findings were retrieved from the full postmortem examinations and autopsy records.


RESULTS
We collected a total of 502 host-pathogen records covering 82 pathogen species, a spectrum that did not change according to patients' therapy or since the onset of the epidemics, which can probably be explained by the fact that even recently deceased patients were usually decompensated (in 95% of the cases, the last available CD4+ cell count was falling below 200 cells*μl-1) regardless of the treatment they received. The newly identified pathogen taxa in HIV-infected patients included Acinetobacter calcoaceticus, Aerococcus viridans and Escherichia hermannii. We observed a very limited overlap in both the spectra and frequencies of the pathogen species found postmortem in HIV-infected patients in Europe, the USA and Latin America.


CONCLUSIONS
The shifts documented previously in compensated HIV-infected patients examined antemortem in the post-HAART era are not recapitulated in mostly decompensated HIV-infected patients examined postmortem.
Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic.|Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.
Marta K
MK
Powell
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.
Kamila
K
Benková
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.|Charles University in Prague, Second Faculty of Medicine, Department of Forensic Medicine, Prague, Czech Republic.
Pavel
P
Selinger
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.|Charles University in Prague, First Faculty of Medicine, Department of Forensic Medicine and Toxicology, Prague, Czech Republic.
Marek
M
Dogoši
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.|Bioptická laboratoř s.r.o., Plzeň, Czech Republic.
Iva
I
Kinkorová Luňáčková
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.
Hana
H
Koutníková
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.
Jarmila
J
Laštíková
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.
Alena
A
Roubíčková
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.
Zuzana
Z
Špůrková
Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic.|Charles University in Prague, Second Faculty of Medicine, Department of Forensic Medicine, Prague, Czech Republic.
Lucie
L
Laclová
Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic.|Teaching Hospital Královské Vinohrady, Department of Pathology, Prague, Czech Republic.
Václav
V
Eis
Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic.|Teaching Hospital Královské Vinohrady, Department of Pathology, Prague, Czech Republic.
Josef
J
Šach
Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic.
Petr
http://orcid.org/0000-0002-0703-951X
P
Heneberg
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001344:Autopsy; D018791:CD4 Lymphocyte Count; D018153:Czech Republic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D011180:Postmortem Changes; D012111:Residence Characteristics; D013045:Species Specificity