Survival of HIV-infected patients admitted to the intensive care unit in the era of highly active antiretroviral therapy

Abstract

We retrospectively studied outcomes for HIV-infected patients admitted to the intensive care unit (ICU) between January 1999 and June 2009. Patient demographics, receipt of highly active antiretroviral therapy (HAART), reason for ICU admission and survival to ICU and hospital discharge were recorded. Comparison was made against outcomes for general medical patients contemporaneously admitted to the same ICU. One hundred and ninety-two HIV-infected patients had 222 ICU admissions; 116 patients required mechanical ventilation (MV) and 43 required renal replacement therapy. ICU admission was due to an HIV-associated diagnosis in 113 patients; 37 had Pneumocystis pneumonia. Survival to ICU discharge and hospital discharge for HIV-infected patients was 78% and 70%, respectively, and was 75% and 68% among 2065 general medical patients with 2274 ICU admissions; P = 0.452 and P = 0.458, respectively. HIV infection was newly diagnosed in 42 patients; their ICU and hospital survival was 69% and 57%, respectively. From multivariable analysis, factors associated with ICU survival were patient's age (odds ratio [OR] = 0.74 [95% confidence interval (CI) = 0.53-1.02] per 10-year increase), albumin (OR = 1.05 [1.00-1.09] per 1 g/dL increase), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 0.55 [0.35-0.87] per 10 unit increase), receipt of HAART (OR = 2.44 [1.01-4.94]) and need for MV (OR = 0.14 [0.06-0.36]). In the era of HAART, HIV-infected patients should be offered ICU admission if it is likely to be of benefit.

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

“…Despite this and similar to prior studies, CD4 count and PVL were not independently associated with short-term mortality [3, 9, 27–30]. Instead, acute illness severity was strongly associated with mortality in our study, an effect which has been demonstrated in several other studies [6, 9, 31–33]. …”

“…Several retrospective studies have had similar findings [5, 13, 27, 30, 34, 35]. Only two recent studies demonstrated a survival benefit with cART [6, 9]. While HIV control may predict survival over the longer term [31], early death appears to be largely driven by acute illness severity and not markers of HIV control.…”

The burden of sepsis in critically ill human immunodeficiency virus-infected patients—a brief review

“…27,28 In contrast, in developing settings those figures are lower, reflecting the high rates of late HIV presenters and opportunistic infections commonly seen in those places. 15 Modern ICU standards of care unrelated to HIV therapy (i.e.…”

Pharmacological Considerations in Human Immunodeficiency Virus–Infected Adults in the Intensive Care Unit

“…2,3 The most effective reduction in viral load and restoration of immune function require a combination of antiretroviral drugs. Currently, more than 20 antiretroviral drugs divided into 6 drug classes according to the mechanism of action are used in ART: nucleoside/ nucleotide reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, chemokine receptor 5 antagonists, and integrase strand transfer inhibitors.…”

“…In the scenario, the proton pump inhibitor could be replaced by another agent, such as an H 2 Continuing or Stopping ART in the ICU No clear evidence indicates whether an established ART regimen should be continued or stopped when a known HIV-infected patient is admitted to the ICU. 2,3 As previously noted, the risk for drug-drug interactions is marked. However, other issues may also present administration challenges.…”