HIV-positive patients in the intensive care unit: A retrospective audit

Abstract

HIV/AIDS is a major public health burden, with an estimated 35.3 million people infected globally. [1] Sub-Saharan Africa (SSA) bears the brunt of the pandemic, with 25 million HIV-positive people living in the region. [1] The advent of highly active antiretroviral therapy (HAART) has changed the natural history of HIV/AIDS, with a reported decline in mortality from 24.5 per 100 person-years in 1995 to 8.9 per 100 in 1997, [2] and reportedly 2.1 per 100 in 2010. [3] Today HIV-positive patients in high-income countries are reported to have a life expectancy approaching that of the general population. [4] Despite evidence of the role of HAART in decreasing morbidity and mortality in HIV-positive patients, in resource-poor settings many people living with HIV do not have access to HAART or receive treatment late. Globally, only 9.7 million people were estimated to be receiving HAART in 2012. [5] Many HIV-positive people present with serious illnesses that may require intensive care unit (ICU) admission, [6] and a large proportion of these are unaware of their HIV status. [7] Data from high-income countries suggest that 7 -12% of HIV-positive patients admitted to hospital are treated in the ICU. [8,9] Historically, respiratory failure accounted for the majority of ICU admissions in the HIV-positive patient population, with an associated mortality of ~70%. [9,10] However, contemporary evidence from high-income countries suggests that ICU outcomes are similar to those of HIV-negative patients and that the indications for ICU are mostly not related to opportunistic infections (OIs). [10,11] ICU utilisation and outcomes for HIV-positive patients in poorly resourced settings, where access to both intensive care and HAART is limited, have not been widely studied. With an increasing prevalence of HIV and an unchanging (and at times decreasing) number of available ICU beds, it is imperative to know the profile and outcome of HIV-positive patients requiring ICU admission in a resource-poor setting such as South Africa (SA). ObjectiveTo identify indications for ICU admission and determine factors associated with high ICU and hospital mortality in HIV-positive patients admitted to ICUs in a resource-limited setting. This will help in determining the appropriateness of offering ICU care to HIVpositive patients and in the appropriate development of policies and planning for allocation of limited resources. Methods Study design and patient populationThe study was a retrospective folder review conducted from 1 January 2012 to 31 December 2012 in the medical and surgical ICUs at Groote Schuur Hospital (GSH), Cape Town, SA. GSH is a tertiary hospital affiliated to the University of Cape Town (UCT), and is an 867-bed institution with 16 general medicine and general surgery adult ICU beds (excluding the coronary care unit, the neurosurgical ICU and This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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

“…In keeping with the findings of other studies , there were statistically significant differences in both the median APACHE II score and the median SOFA score between those who died and those who survived. Although the RAMR of 0.51 in this study may be an indicator of the quality of ICU care, it may also indicate that the APACHE II score has a tendency to overestimate mortality in HIV‐infected ICU patients by approximately two‐fold.…”

Community-acquired bacterial pneumonia in adult HIV-infected patients

“…We recommend that such patients do not need treatment, admission, or care sites that differs from that of the general population. 13,14,15,17,18,19,20,22,23,24,25,27,28,29,30,62,63,66,67,68,70,71 A c c e p t e d M a n u s c r i p t…”

Results from the first audit of an intensive care unit in Botswana

“…The length of ICU stay was 10.3 days, similar to a regional adult ICU study length of stay of 11.8 days. [25] Other South African studies have shown disparate results [26,27] reflecting differing predominance of HIVpositive patients or surgical populations. In the secondary analysis of the 159 patients with known HIV status, HIV-negative patients had statistically significant higher APACHE II scores than HIV-positive patients.…”