Pulmonary complications of HIV infection: autopsy findings

Abstract

Study objectives: To describe the pulmonary complications in patients with HIV infection, and the changes in the incidence of these complications over a 12-year period.

Design: Retrospective review of autopsy records.

Setting: Two university-affiliated medical centers.

Patients: We studied autopsy findings from 233 patients with HIV infection who died between 1985 and 1996. Demographic data, risk factors for HIV infection, and the lengths of hospital stay were obtained. The histologic and microbiological findings of the respiratory system, and the extrapulmonary organ involvement by Kaposi's sarcoma (KS), Pneumocystis carinii, Mycobacterium tuberculosis, and Mycobacterium avium complex were reviewed.

Results: Ninety-two percent of the patients were black and 75% were male. The two most common identified risk factors for HIV infection were homosexuality (34%) and injection drug use (27%). Bacterial pneumonia was the most frequent pulmonary complication (42%). The two most common causes of bacterial pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. P carinii pneumonia (PCP) was found in 24%, with extrapulmonary involvement in 13%. Pulmonary mycobacterial infections were seen in 33%, with multiple extrapulmonary involvement. The most common site affected by KS was the lung. Of all pulmonary complications, only the incidence of PCP decreased over the 12-year period.

Conclusions: Recognizing the high incidence rate of bacterial pneumonia, the high frequency of pulmonary KS and the not uncommon occurrence of extrapulmonary P carinii infection in patients with HIV helps in improving their care.