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. 2016 Sep 9;11(9):e0162704.
doi: 10.1371/journal.pone.0162704. eCollection 2016.

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

Marta K Powell  1   2 , Kamila Benková  2 , Pavel Selinger  2   3 , Marek Dogoši  2   4 , Iva Kinkorová Luňáčková  2   5 , Hana Koutníková  2 , Jarmila Laštíková  2 , Alena Roubíčková  2 , Zuzana Špůrková  2 , Lucie Laclová  2   3 , Václav Eis  1   6 , Josef Šach  1   6 , Petr Heneberg  1
Affiliations

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

Marta K Powell et al. PLoS One. .

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Canonical correspondence analysis of 14 normalized variables with pathogen occurrence in autopsied HIV-infected Czech patients.
The variables analyzed were abbreviated according to the first letters of each respective variable and included sex, age, CDC HIV infection stage classification (abbreviated as “stage A-C” and “stage 1–3”), calendar year of the patient´s death, heart complications (presence/absence), atherosclerotic vascular disease of large blood vessels (severity scale from 0 to 3), atherosclerotic vascular disease of coronary arteries (severity scale from 0 to 3), presence of any neoplasms, presence of a particular neoplasm type (namely, lymphoma, lung carcinoma, Kaposi carcinoma and other carcinomas), and evidence of past antiretroviral therapy. Species names were abbreviated as the first three letters of the genus and species name. Alternatively the abbreviation “spp” was used when multiple species of a single genus were analyzed together. The analysis also included the species’ total counts of pathogens identified in each patient, and a binary criterion stating the presence or absence of sepsis in each patient.
Fig 2
Fig 2. Venn diagram displaying the overlap between the pathogens identified in the autopsied HIV-infected patients included in this study (Czech Republic, Central Europe, n = 124 patients, 502 host-pathogen records), USA (n = 206 patients, 380 host-pathogen records [–15]), Latin America (n = 393 patients, 639 host-pathogen records [–20]) and W & SW Europe (n = 592 patients, 996 host-pathogen records [–12]).
See this image and copyright information in PMC

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