The burden of sepsis in critically ill human immunodeficiency virus-infected patients—a brief review

Abstract

Since the advent of highly active antiretroviral therapy in 1996, we have seen dramatic changes in morbi-mortality rates from human immunodeficiency virus-positive patients. If on the one hand, the immunologic preservation-associated with the use of current antiretroviral therapy markedly diminishes the incidence of opportunistic infections, on the other hand it extended life expectancy of human immunodeficiency virus-infected individuals similarly to the general population. However, the management of critically ill human immunodeficiency virus-infected patients remains challenging and troublesome for practicing clinician. Sepsis - a complex systemic inflammatory syndrome in response to infection - is the second leading cause of intensive care unit admission in both human immunodeficiency virus-infected and uninfected populations. Recent data have emerged describing a substantial burden of sepsis in the infected population, in addition, to a much poorer prognosis in this group. Many factors contribute to this outcome, including specific etiologies, patterns of inflammation, underlying immune dysregulation related to chronic human immunodeficiency virus infection and delays in prompt diagnosis and treatment. This brief review explores the impact of sepsis in the context of human immunodeficiency virus infection, and proposes future directions for better management and prevention of human immunodeficiency virus-associated sepsis.

The effect of HIV status on clinical outcomes of surgical sepsis in KwaZulu-Natal Province, South Africa

“…Recent studies have shown that irrespective of the use of HAART, sepsis among HIV-infected patients is increasing, while the incidence of acute respiratory insufficiency and Pneumocystisrelated pneumonia is decreasing. [7][8][9] In HIV-infected patients, sepsis accounted for 12 -31% of HIV-positive patients' admission to intensive care units (ICUs), and was associated with a worse prognosis. [7][8][9][10] Despite the significant prevalence of the disease in KZN, the impact of HIV co-infection on the clinical outcome of surgical patients in our setting remains largely unknown.…”

“…[7][8][9] In HIV-infected patients, sepsis accounted for 12 -31% of HIV-positive patients' admission to intensive care units (ICUs), and was associated with a worse prognosis. [7][8][9][10] Despite the significant prevalence of the disease in KZN, the impact of HIV co-infection on the clinical outcome of surgical patients in our setting remains largely unknown. Over a decade ago, and prior to the national roll-out of the HAART programme, a study by Cacala et al [2] showed that HIV status does not influence the clinical outcome in general surgical patients.…”

“…This is in contrast to the documented poorer outcome of sepsis in HIV-infected patients. [7][8][9][10] In these studies, no differentiation is made between patients with surgical sepsis and those without.…”

Outcomes and factors influencing outcomes of critically ill HIV-positive patients in a tertiary care center in South India

“…PLHIV with sepsis have a poorer prognosis due to delay in diagnosis and prompt treatment, and altered pattern of immune response due to immune dysregulation associated with chronic HIV infection. [1214]…”

Hospitalização de adultos com Aids em unidade de terapia intensiva: estudo analítico

“…This data is lower compared to the findings in this study (89.5%). Furthermore, sepsis is related to increased length of stay in the ICU (26) . This, in turn, was also a variable with statistical significance in the outcome of ICU admission, which reflects its impact on the health condition of HIV-positive patients.…”