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Powell MK, Benková K, Selinger P, Dogoši M, Kinkorová Luňáčková I, Koutníková H, Laštíková J, Roubíčková A, Špůrková Z, Laclová L, Eis V, Šach J, Heneberg P. 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. PLoS One 2016; 11:e0162704. [PMID: 27611681 PMCID: PMC5017746 DOI: 10.1371/journal.pone.0162704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/27/2016] [Indexed: 12/05/2022] Open
Abstract
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. Design 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.
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Affiliation(s)
- Marta K. Powell
- Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
| | - Kamila Benková
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
| | - Pavel Selinger
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
- Charles University in Prague, Second Faculty of Medicine, Department of Forensic Medicine, Prague, Czech Republic
| | - Marek Dogoši
- 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
| | - Iva Kinkorová Luňáčková
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
- Bioptická laboratoř s.r.o., Plzeň, Czech Republic
| | - Hana Koutníková
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
| | - Jarmila Laštíková
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
| | - Alena Roubíčková
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
| | - Zuzana Špůrková
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
| | - Lucie Laclová
- Na Bulovce Hospital, Pathological-Anatomical Department, Prague, Czech Republic
- Charles University in Prague, Second Faculty of Medicine, Department of Forensic Medicine, Prague, Czech Republic
| | - Václav Eis
- Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic
- Teaching Hospital Královské Vinohrady, Department of Pathology, Prague, Czech Republic
| | - Josef Šach
- Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic
- Teaching Hospital Královské Vinohrady, Department of Pathology, Prague, Czech Republic
| | - Petr Heneberg
- Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic
- * E-mail:
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