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

Abstract

Objective AIDS-related mortalityhas 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 spectrumof pathogens remain, although detailed analyses are lacking. Therefore, we focused on the possible frequency and spectrumshifts in pathogens associated with autopsied HIVinfected patients. Design We hypothesized that the pathogens frequency and spectrumchanges found in HIVinfected patients examined postmortemdid not recapitulate the changes found previously in HIV-infected patients examined antemortemin 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 theWest 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 postmortemexaminations 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 postmortemin 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.