We conducted a retrospective study to assess the reasons for admission to the intensive care unit, and subsequent outcome, in patients infected with the human immunodeficiency virus (HIV). Four hospitals in the south of England participated, all with specialist HIV units. Data were collected on 127 patients admitted to ICU on 133 separate occasions between June 1993 and October 1997. The mean age on admission was 38 years (range 23–60 years). Ninety‐four patients (70.7%) were documented HIV‐positive before admission and 36 (27%) were diagnosed HIV‐positive for the first time during admission; 36.1% were admitted with Pneumocystis carinii pneumonia. Overall ICU mortality was 33%, in‐hospital mortality was 56% and the eventual mortality at the end of follow‐up (March 1998) was 72%. Survival was highest in those admitted with respiratory HIV‐related disease or HIV‐unrelated illness. Associations with poor outcome included a prior AIDS‐defining illness, a CD4 cell count of less than 100 cells.ml−1 and admission secondary to sepsis.

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The objective of this prospective, observational study was to define the natural history of neutropenia in human immunodeficiency virus (HIV) disease. Eighty-seven consecutive patients developing neutropenia (absolute neutrophil count [ANC], <1000 cells/mm(3)) were recruited and closely followed for the duration of the episode. Episodes lasted a median of 13 days, with a mean ANC nadir of 660 cells/mm(3). Presumed or proven infection occurred in 12 (17%) of 71 evaluable subjects, and culture-proven infection occurred only in 6 (8%) of 71. Most of the episodes of neutropenia were brief, mild to moderate in nadir, and self-limiting without complications. Myelosuppressive therapies were implicated in almost all episodes. Serious infections occurred infrequently and were associated with low ANC nadirs but not with duration of the neutropenic episode. Low CD4(+) cell counts also increased the risk of infection complicating an episode of neutropenia.

The complications of human immunodeficiency virus (HIV) infection can result in life-threatening dysfunction requiring support in the intensive careunit (ICU). HIV is frequently overlooked as part of the differential diagnosis in those presenting with acute life-threatening infection. Consideration of the possibility of HIV infection and its related disorders, even in areaswhere HIV is thought uncommon, is increasingly important. Failure to do so may result in a fatal outcome or a more complicated course of illness, as well as inadvertently denying those patients that survive access to new treatments.