Changing patterns of infections in patients with AIDS: A study of 279 autopsies of prison inmates and nonincarcerated patients at a University Hospital in Eastern Texas, 1984-1993

Reports on autopsies of 279 persons infected with human immunodeficiency virus (HIV) were reviewed retrospectively to determine changes in survival rates and infections and to identify differences between prison inmates and nonincarcerated patients. The 78 cases from 1984 through 1988 were compared with 201 from 1989 through 1993, on the basis of use of antiretroviral therapy and (after 1988) prophylaxis against Pneumocystis carinii pneumonia (PCP). Risk factors for HIV infection were homosexuality/bisexuality (30%), injection drug use (IDU; 22%), transfusion (5%), heterosexual contact (4%), and combinations of the above or unknown factors (38%); 95% of patients were males and 41% were state prison inmates in Texas. IDU was more common and homosexuality/bisexuality was less common among inmates than among nonincarcerated patients. Mean survival time was 12 months in the first period studied and 23 months in the later period (P < .05). Cytomegalovirus infection was the most common type in both periods. The number of cases of PCP declined and the number of cases of bacterial infections increased significantly in the later period. Tuberculosis was significantly more common in inmates than in nonincarcerated patients. Tuberculosis and disseminated histoplasmosis (noted at autopsy) and deaths due to disseminated Mycobacterium avium complex and histoplasmosis were significantly more common among injection drug users than among homosexuals/bisexuals. Invasive candidiasis was more common in homosexuals/bisexuals and in those who survived >3 years. Antiretroviral therapy, prophylaxis for PCP, and risk factors for HIV infection appear to influence the mortality rate and prevalence of certain infections found at autopsy.