Author(s): Ansari NA, Kombe AH, Kenyon TA, Hone NM, Tappero JW,
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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 Kaposi's 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.
This article was published in Int J Tuberc Lung Dis
and referenced in Epidemiology: Open Access