Admissions to intensive care unit of HIV-infected patients in the era of highly active antiretroviral therapy: etiology and prognostic factors

Abstract

IntroductionAlthough access to highly active antiretroviral therapy (HAART) has prolonged survival and improved life quality, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support in intensive care units (ICU). This study aimed to describe the etiology and analyze the prognostic factors of HIV-infected Taiwanese patients in the HAART era.MethodsMedical records of all HIV-infected adults who were admitted to ICU at a university hospital in Taiwan from 2001 to 2010 were reviewed to record information on patient demographics, receipt of HAART, and reason for ICU admission. Factors associated with hospital mortality were analyzed.ResultsDuring the 10-year study period, there were 145 ICU admissions for 135 patients, with respiratory failure being the most common cause (44.4%), followed by sepsis (33.3%) and neurological disease (11.9%). Receipt of HAART was not associated with survival. However, CD4 count was independently predictive of hospital mortality (adjusted odds ratio [AOR], per-10 cells/mm3 decrease, 1.036; 95% confidence interval [CI], 1.003 to 1.069). Admission diagnosis of sepsis was independently associated with hospital mortality (AOR, 2.91; 95% CI, 1.11 to 7.62). A hospital-to-ICU interval of more than 24 hours and serum albumin level (per 1-g/dl decrease) were associated with increased hospital mortality, but did not reach statistical significance in multivariable analysis.ConclusionsRespiratory failure was the leading cause of ICU admissions among HIV-infected patients in Taiwan. Outcome during the ICU stay was associated with CD4 count and the diagnosis of sepsis, but was not associated with HAART in this study.

Mortality of patients infected with HIV in the intensive care unit (2005-2010): significant role of chronic hepatitis C and severe sepsis

“…+ cell count with mortality risk [11,37]. Our study was retrospective, and the acquisition of the clinical data related to HIV infection and UCI was unavailable from MBDS records.…”

Epidemiology and Outcomes in Critically Ill Patients with Human Immunodeficiency Virus Infection in the Era of Combination Antiretroviral Therapy

“…However, the introduction of combination antiretroviral therapy (cART) in 1996 changed the landscape of HIV care dramatically, with substantial reductions in morbidity and mortality in HIV-infected patients [5–9]. HIV infection is now a chronic disease rather than a terminal illness [7, 8, 10].…”

Bloodstream infections in HIV-infected patients

“…11 BSI are now a more frequent cause of ICU admission than Pneumocystis jiroveci pneumonia in HIV-infected patients. 12,13 Nontyphoid salmonella, Streptococcus pneumoniae, Escherichia coli and Staphylococcus aureus are the most important pathogens of BSI. Fungal and mycobacterial infections are less frequent but can have considerable clinical and economic impact.…”