16.0 Death and clinico-pathological audit of HIV-associated tuberculosis

Despite diagnosis and treatment, patients with HIV and tuberculosis still die.143 It is important that as many such patients as feasible are examined by autopsy after death. This categorises the causes of death and enables audit of medical practice. The significant categories of pathology include:

  1. death from active, progressive tuberculosis
  2. death from IRIS affecting one or more critical organs (eg lung, brain), or from anti-TB drug toxicity
  3. death from other HIV-related or non-HIV-related disease in a person who was effectively treated for tuberculosis
  4. death from other disease in a person diagnosed with and treated for tuberculosis, without laboratory confirmation, who shows at autopsy no evidence of having had tuberculosis

 

If the interval between TB culture positivity and death is <=3 months, culture of tuberculous autopsy tissue should be performed to evaluate drug sensitivity and bacterial viability

Autopsies are either requested by clinicians or (in UK) commanded by a Coroner or Procurator Fiscal. If the autopsy is coronial, every endeavour should be made to obtain the autopsy report for clinical audit. Before any autopsy, contact with the appointed pathologist to discuss the clinico-pathological issues is recommended. Pathology staff should  adopt suitableuniversal infection control precautions against airborne and blood borne pathogens