Omar Tanvier, Sabet Nadia, Calver Alistair, Chita Gajendra, Hermans Lucas E, Venter Willem D F, Basson Adriaan, Nijhuis Monique, Wensing Annemarie, Martinson Neil, Papathanasopoulos Maria, Variava Ebrahim
Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
South Afr J HIV Med. 2025 May 9;26(1):1673. doi: 10.4102/sajhivmed.v26i1.1673. eCollection 2025.
Mortality among people living with HIV (PLWH) in developing settings remains elevated, despite high coverage with antiretroviral therapy (ART), with 70% - 80% being virally suppressed (VS).
This study aimed to determine cause-specific mortality in PLWH in South Africa.
An autopsy study with detailed medical record review was undertaken in PLWH dying in hospital. Minimally invasive autopsies were performed on 38 VS and 21 unsuppressed PLWH (≥ 18 years) dying in hospital between May 2018 and April 2022. We assessed clinical and histological findings to determine underlying, contributing, and immediate causes of death (CODs).
Median CD4 counts were 180 and 42 cells/mm in patients with and without VS respectively. Leading immediate CODs in both VS and unsuppressed PLWH were respiratory failure, sepsis, and septic shock; leading contributing CODs in decreasing order of frequency in both groups were acute kidney injury (AKI), bacterial pneumonia, immunological failure, gastroenteritis and current tuberculosis. Leading underlying CODs in both groups were hypertension, current tuberculosis, malignancies, and chronic obstructive pulmonary disease. VS was associated with lower risk of septic shock and AKI.
VS on ART appeared to reduce risk of death from specific pathologies. However, infections, multi-organ failure, non-AIDS-defining malignancies, and metabolic diseases remain important CODs. Incomplete immune reconstitution appears to be a key contributor to premature death.
尽管抗逆转录病毒疗法（ART）的覆盖率很高，且70%-80%的艾滋病毒感染者（PLWH）实现了病毒抑制（VS），但在发展中地区，PLWH的死亡率仍然居高不下。
本研究旨在确定南非PLWH的特定病因死亡率。
对在医院死亡的PLWH进行了一项尸检研究，并详细审查了病历。对2018年5月至2022年4月期间在医院死亡的38例病毒抑制的PLWH和21例未实现病毒抑制的PLWH（≥18岁）进行了微创尸检。我们评估了临床和组织学检查结果，以确定潜在、促成和直接死因（COD）。
病毒抑制组和未抑制组患者的CD4细胞计数中位数分别为180个/mm³和42个/mm³。病毒抑制组和未抑制组PLWH的主要直接死因均为呼吸衰竭、败血症和感染性休克；两组中按频率递减顺序排列的主要促成死因均为急性肾损伤（AKI）、细菌性肺炎、免疫功能衰竭、胃肠炎和现患结核病。两组的主要潜在死因均为高血压、现患结核病、恶性肿瘤和慢性阻塞性肺疾病。病毒抑制与感染性休克和AKI的较低风险相关。
接受ART治疗实现病毒抑制似乎降低了特定病理导致的死亡风险。然而，感染、多器官功能衰竭、非艾滋病定义的恶性肿瘤和代谢性疾病仍然是重要的死因。免疫重建不完全似乎是过早死亡的一个关键因素。
