Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients

Abstract

The introduction of highly active antiretroviral therapy with protease inhibitors in 1996 has changed the morbidity and mortality of acquired immune deficiency syndrome patients. Therefore, the aetiologies and prognostic factors of human immunodeficiency virus (HIV)-infected patients with life-threatening respiratory failure requiring intensive care unit (ICU) admission need to be reassessed.From 1993 to 1998, we prospectively evaluated 57 HIV patients (mean±sem age 36.5±1.3 yrs) admitted to the ICU showing pulmonary infiltrates and acute respiratory failure.A total of 21 and 30 patients were diagnosed as havingPneumocystis cariniiand bacterial pneumonia, respectively, of whom 13 and eight died during their ICU stay (p=0.01). Both groups of patients had similar age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and severity in respiratory failure. The number of cases with bacterial pneumonia admitted to ICU decreased after 1996 (p=0.05). Logistic regression analysis showed that (APACHE) II score >17, serum albumin level <25 g·L−1, and diagnosis ofP. cariniipneumonia were the only factors at entry associated with ICU mortality (p=0.02).Patients with bacterial pneumonia are less frequently admitted to the intensive care unit after the introduction of highly active antiretroviral therapy with protease inhibitors in 1996. Compared to the previous series, it was observed that the fewPneumocystis cariniipneumonia patients that need intensive care still have a bad prognosis.

Comparing Outcomes of HIV versus Non-HIV Patients Requiring Mechanical Ventilation

“…6,8,11 Due to a better understanding of the disease, HAART, and the availability of prophylaxis for PCP, bacterial pneumonia has emerged as the main cause of respiratory failure and ICU admission. 10,[12][13][14] In the present study, respiratory failure was the most common indication for ICU intubation in HIVinfected patients, followed by airway protection and sepsis. Several studies suggest that mortality following MV is particularly high in HIV-infected patients.…”

Pulmonary infections in HIV-infected patients: an update in the 21st century

“…ICU care was perceived as futile by physicians. Since then, the proportion of ICU admissions caused by respiratory failure has declined, but respiratory failure remains the most common indication for ICU admission in the current era of HAART [152,155]; bacterial pneumonia and PCP are the leading causes of acute respiratory failure, but the proportion of PCP has decreased [155][156][157]. Survival for critically ill HIV-infected patients continues to improve in the current era and could be comparable to the overall survival in non-HIV ICU patients [155,158].…”

Current issues in critical care of the human immunodeficiency virus-infected patient*

“…In a cohort of 169 HIV-infected ICU patients hospitalized between 1995 and 1999, Afessa and colleagues (10) reported 30% in-hospital mortality rate. A Spanish cohort studied from 1993 to 1998 had 40% ICU mortality (11). Nuesch and colleagues (12) found stable ICU mortality rates of 29% and 25% in the time periods from 1994 to 1996 and 1997 to 1999, respectively.…”