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Survival of HIV-infected patients in the intensive care unit in the era of highly active antretroviral therapy
  1. Stuart J Dickson (sjdickson{at}doctors.org.uk)
  1. University College London Hospitals, United Kingdom
    1. Steven Batson
    1. University College London Hosptials, United Kingdom
      1. Andrew Copas (acopas{at}gum.ucl.ac.uk)
      1. University College London, United Kingdom
        1. Simon G Edwards
        1. Camden PCT, United Kingdom
          1. Mervyn Singer (m.singer{at}ucl.ac.uk)
          1. University College London, United Kingdom
            1. Robert F Miller (rmiller{at}gum.ucl.ac.uk)
            1. University College London, United Kingdom

              Abstract

              Background: Several studies describe improved outcomes for HIV-infected patients admitted to the intensive care unit (ICU) since the introduction of highly active antiretroviral therapy (HAART).

              Objective: To describe outcome from ICU for HIV-infected patients and to identify prognostic factors.

              Methods: Retrospective study of HIV-infected adults admitted to a university-affiliated hospital ICU between January 1999 and December 2005. Information on patient demographics, receipt of HAART, (no patient began HAART on the ICU), reason for ICU admission and hospital course was collected. Outcomes were survival to ICU discharge and to hospital discharge.

              Results: One hundred and two patients had 113 admissions to the ICU; HIV infection was newly diagnosed in 31 patients. Survival (first-episode ICU discharge and hospital discharge) was 77% and 68%, respectively; by contrast, ICU and hospital survival among general medical patients was 74% and 65%. ICU and hospital survival was 78% and 67% in those receiving HAART, and 75% and 66% in those who were not. In univariate analysis factors associated with survival were: haemoglobin, Odds Ratio (OR)=1.25 for a 1g/dL increase, 95% confidence interval (CI)=1.03-1.51; CD4 count (OR for a 10-fold increase in cells/μL=1.59, 95% CI=0.98-2.58); APACHE II score, (OR for a 10 unit increase=0.51, 95% CI=0.29-0.90) and mechanical ventilation, (OR=0.29, 95% CI=0.10-0.83).

              Conclusions: In this study the outcome for HIV-infected patients admitted to the ICU was good and was comparable with that among general medical patients. Over a quarter of patients had newly diagnosed HIV infection. Patients receiving HAART did not have a better outcome.

              • AIDS
              • HIV infection
              • intensive care unit
              • mechanical ventilation
              • prognosis

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