Correlação clínico-patológica em pacientes HIV/AIDS submetidos à autópsia: uma abordagem retrospectiva

Abstract

Introduction: In just over 40 years, HIV infection went from being a problem restricted to certain population groups at risk to a global epidemic, with a major impact on health. With the advent of antiretroviral therapy (ART), there have been changes over time in the causes of death and pathological findings in HIV/AIDS patients, with an increase in the prevalence of serious illnesses unrelated to AIDS. The analysis of concordance rates between ante-mortem diagnosis and post-mortem diagnosis is one of the main ways of evaluating diagnostic performance, as well as monitoring changes in causes of death in this population, using autopsy as the gold standard. Objective: To evaluate the general concordance between ante-mortem clinical diagnoses of causes of death and autopsy diagnoses, in HIV/AIDS patients subjected to autopsy at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), from 2014 to 2019. Methodology: This is a cross-sectional and retrospective study, with the study population being HIV/AIDS patients followed at FMT-HVD who died and underwent autopsy between 2014 and 2019. The observed concordance and Kappa index were used to compare the results of the ante-mortem clinical diagnosis and the autopsy. The discordances identified were categorized according to the Goldman classification. Results: One hundred and one autopsies were included in the study and a total of 48/101 cases (47.6%) were identified as cases of class I discordance, in which the autopsy revealed a diagnosis different from the clinical diagnosis, with potential impact on the patient survival or treatment. Critical findings such as untreated infections (37 of 48 cases; 77.1%), undiagnosed neoplasms (8 of 48 cases; 16.7%) and other pathologies (3 of 48 cases; 6.2%) were categorized in this class. There was 36.7% overall agreement on the underlying cause of death, and the majority of patients died from AIDS-related illnesses. Conclusion: The overall rate of clinical-pathological discordance was 63.3%, which demonstrates that the autopsy examination continues to be an important tool for determining the causes of death, especially in patients affected by HIV, in addition to its implications for research and for teaching medical professionals.