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Temporal trends in critical events complicating HIV infection: 1999–2010 multicentre cohort study in France

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Abstract

Purpose

Multicentre data are limited to appraise the management and prognosis of critically ill human immunodeficiency virus (HIV)-infected patients. We sought to describe temporal trends in demographic and clinical characteristics, indications for intensive care and outcome in this patient population.

Methods

We conducted a cohort study of unselected HIV-infected patients admitted between 1999 and 2010 to 34 French ICUs contributing to the CUB-Réa prospective database.

Results

We included 6,373 consecutive patients. Over the 12-year period, increases occurred in median age (39 years in 1999–2001; 47 years in 2008–2010, p < 0.0001) and prevalence of comorbidities (notably malignancies, from 6.7 to 16.4 %, p < 0.0001). Admissions for respiratory failure (39.8 % overall), shock (8.1 %) and coma (22.7 %) decreased (p < 0.0001), while those for sepsis (19.3 %) remained stable. The main final diagnoses were bacterial sepsis (24.6 %) and non-bacterial acquired immune deficiency syndrome (AIDS)-defining diseases (steady decline from 26.0 to 17.5 %, p < 0.0001). Patients increasingly received mechanical ventilation (from 42.9 to 54.0 %) and renal replacement therapy (from 9.6 to 16.8 %) (p < 0.0001), whereas vasopressor use remained stable (27.4 %). ICU readmissions increased after 2004 (p < 0.0001). ICU and hospital mortality (17.6 and 26.9 %, respectively) dropped markedly in the most severely ill patients requiring multiple life-sustaining therapies. Malignancies and chronic liver disease were heavily associated with hospital mortality by multivariate analysis, while the most common AIDS-defining complications (Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis and tuberculosis) had no independent impact.

Conclusions

Progressive ageing, increasing prevalence of comorbidities (mainly malignancies), a steady decline in AIDS-related illnesses and improved benefits from life-sustaining therapies were the main temporal trends in HIV-infected patients requiring ICU admission.

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Acknowledgments

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Conflicts of interest

All authors declare that they have no conflict of interest relevant to the present study.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Élie Azoulay.

Additional information

For the CUB-Réa Network. Members of the CUB-Réa Network are listed in the “Appendix”.

Take-home message: Progressive ageing, increasing prevalence of comorbidities (mainly cancer), continuous rarefaction of AIDS-associated illnesses and improved benefit from life-sustaining therapies characterize the current population of HIV-infected patients requiring ICU admission. Comorbidities (such as liver cirrhosis and malignancies) and the extent of organ dysfunctions are heavily associated with hospital survival, while the most common AIDS-defining complications (i.e. Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis and tuberculosis) have no independent impact on short-term outcome.

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Appendix

Appendix

Members for the CUB-Réa Network. Names and affiliations of contributing ICU physicians: F. Brivet (Hôpital Antoine Béclère, Clamart); J-P. Bedos (Hôpital André Mignot, Versailles); A. Vieillard-Baron (Hôpital Ambroise Paré, Boulogne); Y. Cohen (Hôpital Avicenne, Bobigny); C. Richard (Hôpital du Kremlin-Bicêtre, Le Kremlin-Bicêtre); M. Wolff (Hôpital Bichat, Paris); D. Caen (Centre Hospitalier Sud-Francilien, Evry); J-P.Mira (Hôpital Cochin, Paris); F. Fraisse (Hôpital Delafontaine, Saint-Denis); J-Y. Fagon (Hôpital Européen Georges Pompidou, Paris); F. Blin (Hôpital de Gonesse, Gonesse); C. Brun-Buisson (Hôpital Henri Mondor, Créteil); A. Rabbat (Hôpital Hôtel-Dieu, Paris); G. Nitemberg (Institut Gustave Roussy, Villejuif); G. Dhonneur (Hôpital Jean Verdier, Bondy); D. Dreyfus (Hôpital Louis Mourier, Colombes); F. Baud (Hôpital Lariboisière, Paris); J-M. Coulaud (Hôpital Intercommunal Le Raincy-Montfermeil, Montfermeil); L. Pallot (Hôpital André Grégoire, Montreuil); H. Bismuth (Hôpital Paul Brousse, Villejuif); T. Similowski (Hôpital de la Pitié-Salpêtrière, Paris); J. Chastre (Hôpital de la Pitié-Salpêtrière, Paris); F. Bolgert (Hôpital de la Pitié-Salpêtrière, Paris); J-L. Ricome (Centre Hospitalier Intercommunal, Poissy-Saint-Germain-en-Laye); H. Outin (Centre Hospitalier Intercommunal, Poissy-Saint-Germain en Laye); D. Zarka (Hôpital Robert Ballanger, Aulnay sous Bois); D. Annane (Hôpital Raymond Poincaré, Garches), B. Guidet (Hôpital Saint-Antoine, Paris); B. Misset (Hôpital Saint-Joseph, Paris); B. Schlemmer (Hôpital Saint-Louis, Paris); L. Jacob (Hôpital Saint-Louis, Paris); A. Parrot (Hôpital Tenon, Paris); F. Bonnet (Hôpital Tenon, Paris); H. Mentec (Hôpital Victor Dupouy, Argenteuil).

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Barbier, F., Roux, A., Canet, E. et al. Temporal trends in critical events complicating HIV infection: 1999–2010 multicentre cohort study in France. Intensive Care Med 40, 1906–1915 (2014). https://doi.org/10.1007/s00134-014-3481-7

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  • DOI: https://doi.org/10.1007/s00134-014-3481-7

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