Clinicopathological diagnostic concordance among autopsied adults living with HIV in the Brazilian Amazon: A retrospective cross-sectional study

With the emergence of antiretroviral therapy (ART), changes have occurred over time in the causes of death and pathological findings among people living with HIV, including an increasing contribution of serious non-AIDS-related diseases. Assessing concordance between ante-mortem clinical and post-mortem diagnoses remains an important approach for evaluating diagnostic performance and monitoring changes in causes of death in this population. This study aimed to evaluate the concordance between ante-mortem clinical diagnoses of the underlying cause of death and autopsy diagnoses among adults living with HIV who underwent autopsy at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil, between 2014 and 2019. This cross-sectional retrospective study included 101 autopsies. Class I discordances were identified in 48 of 101 cases (47.6%), predominantly involving infectious diseases (37/48; 77.1%), followed by undiagnosed neoplasms (8/48; 16.7%) and other conditions (3/48; 6.2%). Overall concordance for the underlying cause of death was 36.7%, and most deaths were attributable to AIDS-defining diseases. The absence of ART was associated with a higher frequency of class I discordances. The high frequency of major missed diagnoses may also reflect advanced disease at presentation, overlapping clinical manifestations of opportunistic infections, and limitations in the availability of specific diagnostic methods during the study period. Overall clinicopathological discordance was 63.3%, underscoring the continued value of autopsy for identifying missed diagnoses and highlighting the importance of timely clinical assessment and improved access to sensitive and specific diagnostic methods for adults living with HIV.