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

Abstract

IntroductionThe combination antiretroviral therapy (cART) has led to decreased opportunistic infections and hospital admissions in human immunodeficiency virus (HIV)-infected patients, but the intensive care unit (ICU) admission rate remains constant (or even increased in some instances) during the cART era. Hepatitis C virus (HCV) infection is associated with an increased risk for hospital admission and/or mortality (particularly those related to severe liver disease) compared with the general population. The aim of this study was to assess the mortality among HIV-infected patients in ICU, and to evaluate the impact of HIV/HCV coinfection and severe sepsis on ICU mortality.MethodsWe carried out a retrospective study based on patients admitted to ICU who were recorded in the Minimum Basic Data Set (2005 through 2010) in Spain. HIV-infected patients (All-HIV-group (n = 1,891)) were divided into two groups: HIV-monoinfected patients (HIV group (n = 1,191)) and HIV/HCV-coinfected patients (HIV/HCV group (n = 700)). A control group (HIV(-)/HCV(-)) was also included (n = 7,496).ResultsAll-HIV group had higher frequencies of severe sepsis (57.7% versus 39.4%; P < 0.001) than did the control group. Overall, ICU mortality in patients with severe sepsis was much more frequent than that in patients without severe sepsis (other causes) at days 30 and 90 in HIV-infected patients and the control group (P < 0.001). Moreover, the all-HIV group in the presence or absence of severe sepsis had a higher percentage of death than did the control group at days 7 (P < 0.001), 30 (P < 0.001) and 90 (P < 0.001). Besides, the HIV/HCV group had a higher percentage of death, both in patients with severe sepsis and in patients without severe sepsis compared with the HIV group at days 7 (P < 0.001) and 30 (P < 0.001), whereas no differences were found at day 90. In a bayesian competing-risk model, the HIV/HCV group had a higher mortality risk (adjusted hazard ratio (aHR) = 1.44 (95% CI = 1.30 to 1.59) and aHR = 1.57 (95% CI = 1.38 to 1.78) for patients with and without severe sepsis, respectively).ConclusionsHIV infection was related to a higher frequency of severe sepsis and death among patients admitted to the ICU. Besides, HIV/HCV coinfection contributed to an increased risk of death in both the presence and the absence of severe sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0475-3) contains supplementary material, which is available to authorized users.

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

“…Although univariate analysis identified mean age, primary diagnostic category, sepsis acquired during the ICU stay, inotrope/vasopressor administration, mechanical ventilation, haemodialysis, median CD4 cell count, median APACHE II score, median SOFA score and median length of ICU stay as significant factors associated with ICU mortality, only a non‐sepsis diagnosis, inotrope/vasopressor administration and mechanical ventilation were major contributors to ICU mortality in the multivariate analysis. These findings are similar to those of other studies which also evaluated significant contributors to ICU survival/mortality .…”

“…These included poor baseline health, higher severity of acute illness and delayed delivery of critical care . In addition, a higher severity of illness score, low serum albumin, requirement for vasopressor or inotropic support, need for mechanical ventilation, Pneumocystis carinii pneumonia (PCP) diagnosis and the presence of other AIDS‐related illnesses have also been associated with poorer outcomes in patients with HIV infection . Surprisingly, the CD4 cell count and HIV viral load were not shown to predict ICU survival .…”

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

“…Similar to previously published data, our patient population was young (mean age 44 years) [5, 12, 19]. Nearly half of patients were aboriginal and the prevalence of substance use and HCV coinfection were high.…”

Hepatitis C viremia as a risk factor for opportunistic infections in kidney transplant recipients

“…Thus, the immunosuppressive effect of HCV could explain our results. Previous studies assessing the role of HCV as an immunomodulator reported a higher number of infectious complications in liver transplant recipients with HCV infection . Moreover, viral infections caused by CMV, BK virus, or HCV can produce allograft injury through production of proinflammatory cytokines (eg, IL‐1, IL‐6, IL‐8, and tumor necrosis factor alpha) and profibrotic and vasculopathic growth factors (eg, TGF‐beta and platelet‐derived growth factor), which induce proliferation of fibroblasts with a direct effect on the development of chronic allograft dysfunction .…”