Clinical Characteristics and Short-Term Outcomes of HIV Patients Admitted to an African Intensive Care Unit

Abstract

Purpose. In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU. Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference to P < 0.05. Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4, P = 0.01)), mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76, P = 0.01)), and ARDS (OR 4.5 (95% CI: 1.07–16.7, P = 0.04)) had a statistically significant association with mortality. Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.

Patterns of presentation and survival of HIV‐infected patients admitted to a tertiary‐level intensive care unit

“…Unlike the findings of other studies , HIV‐positive patients in this study who died in the ICU were significantly older than those who survived. Morris et al , for example, did not report any differences with regard to age, sex, race, ethnicity or HIV risk factors between survivors and nonsurvivors .…”

“…Morris et al , for example, did not report any differences with regard to age, sex, race, ethnicity or HIV risk factors between survivors and nonsurvivors . In keeping with the findings of Kwizera et al , the median length of ICU stay was marginally but statistically significantly longer in those who survived to discharge from the ICU. A plausible reason for this may be that HIV‐positive individuals who die in the ICU are more acutely ill upon ICU admission.…”

Management of HIV-infected patients in the intensive care unit

“…1) [2,3]. Such patients account for 10-30% of all ICU admissions of HIV-infected individuals, though this proportion appears dwindling over the past decade [4][5][6][7][8][9]. Of note, severely immunosuppressed Take-home messages Fig.…”

“…Lifetime low-level inflammation due to silent HIV replication in sanctuary sites, co-infections (e.g., CMV, EBV or HBV/HCV), intestinal dysbiosis, habitus (e.g., tobacco or intravenous drug use), sequelae of past infectious processes and long-term toxicity of certain antiretroviral medications may be implicated to varying degrees in the pathogenesis of these conditions [10,19,20]. Up to 70% of HIV-infected patients nowadays managed in the ICU are receiving long-term cART [6,8,9,[21][22][23][24]. This epidemiological shift translates into a continuous rise in non-AIDSrelated ICU admissions which broadly exceeded those for severe OIs in most of recent cohorts.…”

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda

“…Both the relatively low rate of HIV infection [20] and the comparatively short duration between symptom onset and presentation to a healthcare facility may have further contributed to the low fatality rate. These observations may reflect the effectiveness of the Rwandese healthcare system and may explain why studies from other sub-Saharan African countries reported higher death rates in patients with acute infection and sepsis [20][21][22]. Our trial was therefore underpowered to detect a difference in hospital mortality.…”