It is because of the problems that diagnostic limitations place on disease reporting that the most reliable information regarding these opportunistic infections is obtained through autopsy. The AIDS Report of 1994 cited a study that researchers in Zaire conducted which compared specific diagnoses and the finding of subsequent autopsies, and the correlation was less than 40%.
It would seem that an important question which still needs to be addressed might be how can we raise the consciousness of physicians and medical institutions and have them continue to perform autopsies. It seems a valid argument that raising the current low rate of autopsies would assist modern medicine by supplying medical professionals with invaluable educational and clinical information. In academic settings, requesting the consent for autopsies is the responsibility of residents, who quite often are not experienced enough to approach the families, request consent and follow up the autopsy results (Welsh, 1998). Perhaps the medical community should structure their training of residents to include and emphasize the importance of the postmortem examination with an emphasis on communication between clinicians, pathologists and families.
In my research, I found that the results noted in Altman's article that he attributed to Dr. Sebastian Lucas were accurate as they were also documented in The AIDS Report of 1994 as well as the EuroCASO dated July 22, 1992. The results were from RETRO-CI the largest H.I.V. autopsy study ever conducted in Africa. The study revealed that tuberculosis was the cause of death in over 35% of the adults with H.I.V. His autopsy studies also showed that Pneumocystis carinii pneumonia or PCP was less common in adults in developing countries compared to the U.S. where it is still the leading complication of H.I.V. This is significant because TB is preventable and treatable. Most of the patients waited until they were in the terminal stages of the disease before they sought treatment.
