Etiology and outcomes for patients infected with HIV in intensive care units in a tertiary care hospital in China

Abstract

Although the National Free Antiretroviral Treatment Program (NFATP) has resulted in a significant reduction in the incidence of AIDS-defining illnesses in China, severe complications in patients infected with HIV may require aggressive treatment and critical care support. The objective for this study was to investigate the etiology and outcomes of patients infected with HIV admitted to intensive care units in Ditan Hospital, China. The evaluation of the etiology and outcomes of patients infected with HIV admitted to intensive care units was conducted using the clinical data from 122 patients infected with HIV (129 occasions) admitted to the Beijing Ditan hospital from January 1, 2009, to October 1, 2013. Over the five-year study period, 129 occasions occurred for 122 patients infected with HIV admitted to intensive care units. Respiratory failure was the most common condition (53.4%) among the 129 occasions analyzed. This was followed by pneumothorax (12.4%), infectious shock (8.5%), neurological problems (8.5%), renal failure (7.8%), post-operative complications and trauma (5.4%), coronary heart disease (3.1%), adverse effects of HAART (3.1%), lymphoma (2.4%), and liver failure (0.8%). Mortality in intensive care units was 64.5% while in-hospital mortality was 65.9%. The strongest protective predictor for in-hospital mortality was earlier admission to an intensive care unit (OR = 0.050, CI = 0.020-0.126, P < 0.001). Respiratory failure was the most common condition in patients infected with HIV admitted to intensive care units, and the outcome for the patients was poor. Mortality was negatively associated with earlier admission to an intensive care unit, but was not associated with HAART.

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.…”

Critical Care in Human Immunodeficiency Virus–Infected Patients

“…13,17,20,25,37,58 Respiratory failure is most frequently associated with infections, including opportunistic and community-acquired infections. 7,13,17,20,25,36,37,39,43,58,59 Nosocomial and drug-resistant infections have been decreasing in frequency overall since the availability of ART but remain important risk factors for hospital mortality. 60 Respiratory failure from noninfectious respiratory conditions such as acute exacerbations of chronic obstructive pulmonary disease (COPD) is also increasingly common and should be considered in the differential diagnosis (►Table 2).…”

“…17,18,[20][21][22]25,[29][30][31][32][33][34][35][36] Respiratory and infectious admission diagnoses, delayed ICU admission from the time of hospital presentation, requirement for mechanical ventilation, and lower serum albumin are also strongly associated with mortality. 17,[20][21][22]25,[32][33][34][36][37][38][39] Chronic liver disease and hepatitis C coinfection are increasingly important predictors for mortality in the current ART era. 13,17,40 While CD4 T cell count and HIV-1 RNA are not directly associated with ICU mortality, 20,26,31,41 HIV may be a risk factor for mortality, even with access to ART, due to prior or ongoing immune suppression and HANA conditions.…”

“…45 Several other studies have failed to show improved ICU or hospital survival among patients on ART. 22,25,37,39 Independent effects of ART alone on ICU mortality may be difficult to demonstrate because these data have been derived from retrospective studies. In addition, medication adherence and viral resistance to ART regimens have not been considered.…”