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Needle Autopsy to Establish the Cause of Death in HIV-Infected Hospitalized Adults in Uganda: A Comparison to Complete Autopsy

Cox, Janneke A. MD*,†; Lukande, Robert L. MD; Kalungi, Sam MD, PhD‡,§; Van Marck, Eric MD, PhD; Van de Vijver, Koen MD, PhD; Kambugu, Andrew MD; Nelson, Ann M. MD#; Manabe, Yukari C. MD†,**; Colebunders, Robert MD, PhD*,††

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 October 2014 - Volume 67 - Issue 2 - p 169–176
doi: 10.1097/QAI.0000000000000290
Clinical Science

Introduction: Minimal invasive but accurate methods to establish the cause of death in HIV-infected patients are needed. We studied the agreement in cause of death between blind and ultrasound-guided needle autopsy and complete autopsy in HIV-infected patients in Uganda.

Methods: We subsequently performed a blind and ultrasound-guided needle autopsy followed by a complete autopsy in HIV-infected adults who died during hospitalization. Two teams of pathologists reviewed the tissue from either the needle autopsies or the complete autopsy and formulated the major diagnoses, that is, diseases directly contributing to death. The primary outcome was concordance in major diagnosis between needle and complete autopsies.

Results: We performed 96 blind needle and complete autopsies and 95 ultrasound-guided needle autopsies. Concordance in major diagnosis between blind needle and complete autopsy was 50%. For the main major diagnosis, tuberculosis (TB) concordance was higher (71%; P < 0.01). Blind needle autopsy identified at least 1 major diagnosis in 60% of patients; and in 46%, there was complete concordance for all major diagnoses. The main reason for discordance was sampling error of the lesion. Concordance with the addition of ultrasound guidance was 52% for all major diagnoses and 79% for TB. Major diagnoses were mainly identified in tissue cores from the liver (76%) and the spleen (82%).

Discussion: Blind needle autopsy identified half of the major diagnosis. The addition of ultrasound guidance did not significantly improve the performance of needle autopsy. Needle autopsy is a valuable method to confirm causes of death in HIV-infected patients, especially for highly prevalent diseases like TB.

*Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;

Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;

Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda;

§Department of Pathology, Mulago Hospital Complex, Kampala, Uganda;

Department of Pathology, University Hospital Antwerp, University of Antwerp, Belgium;

Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;

#Joint Pathology Center, Silver Spring, MD;

**Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; and

††Faculty of Medicine, University of Antwerp, Belgium.

Correspondence to: Janneke A. Cox, MD, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium (e-mail: jannekecox@xs4all.nl).

Supported by Nederlandse Vereniging van HIV-behandelaren, KNCV Tuberculose fonds, and Boehringen Ingelheim B.V., Alkmaar. The biopsy needles were provided at a discounted price by Bard Benelux N.V.

J.A.C. received a travel grant from the Belgium government through the “Fonds Wetenschappelijk Onderzoek” Flanders. The remaining authors have no conflicts of interest to disclose.

All authors have made substantive contributions to the submitted study.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Received March 20, 2014

Accepted June 26, 2014

© 2014 by Lippincott Williams & Wilkins