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.
Similar content being viewed by others
References
Barbier F, Roux A, Canet E et al (2013) Changing use of intensive care in HIV-infected patients: 1999–2010 trends in 34 French ICUs (Abstract A1584). American Thoracic Society International Conference, Philadelphia
Deeks SG, Lewin SR, Havlir DV (2013) The end of AIDS: HIV infection as a chronic disease. Lancet 382:1525–1533
Freiberg, Chang CC, Kuller LH et al (2013) HIV Infection and the risk of acute myocardial infarction. JAMA Intern Med 173:1–9
Crothers K, Huang L, Goulet JL et al (2011) HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era. Am J Respir Crit Care Med 183:388–395
Lanoy E, Spano JP, Bonnet F et al (2011) The spectrum of malignancies in HIV-infected patients in 2006 in France: the ONCOVIH study. Int J Cancer 129:467–475
Akgun KM, Gordon K, Pisani M et al (2013) Risk factors for hospitalization and medical intensive care unit (MICU) admission among HIV-infected veterans. J Acquir Immune Defic Syndr 62:52–59
Crum-Cianflone NF, Grandits G, Echols S et al (2010) Trends and causes of hospitalizations among HIV-infected persons during the late HAART era: what is the impact of CD4 counts and HAART use? J Acquir Immune Defic Syndr 54:248–257
Yehia BR, Fleishman JA, Hicks PL, Ridore M, Moore RD, Gebo KA (2010) Inpatient health services utilization among HIV-infected adult patients in care 2002–2007. J Acquir Immune Defic Syndr 53:397–404
Akgun KM, Tate JP, Pisani M et al (2013) Medical ICU admission diagnoses and outcomes in human immunodeficiency virus-infected and virus-uninfected veterans in the combination antiretroviral era. Crit Care Med 41(6):1458–1467
Barbier F, Coquet I, Legriel S et al (2009) Etiologies and outcome of acute respiratory failure in HIV-infected patients. Intensive Care Med 35:1678–1686
Chiang HH, Hung CC, Lee CM et al (2011) Admissions to intensive care unit of HIV-infected patients in the era of highly active antiretroviral therapy: etiology and prognostic factors. Crit Care 15:R202
Foo H, Clezy K, Post JJ (2012) The long-term outcome of HIV-infected patients after intensive care admission. Int J STD AIDS 23:e4–e8
Powell K, Davis JL, Morris AM, Chi A, Bensley MR, Huang L (2009) Survival for patients with HIV admitted to the ICU continues to improve in the current era of combination antiretroviral therapy. Chest 135:11–17
Dickson SJ, Batson S, Copas AJ, Edwards SG, Singer M, Miller RF (2007) Survival of HIV-infected patients in the intensive care unit in the era of highly active antiretroviral therapy. Thorax 62:964–968
Croda J, Croda MG, Neves A, De Sousa dos Santos S (2009) Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit. Crit Care Med 37:1605–1611
Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B (2004) Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS 18:1429–1433
Aegerter P, Auvert B, Buonamico G et al (1998) Organization and quality control of a clinical database on intensive care medicine in central and suburban Parris. Rev Epidemiol Sante Publique 46:226–237
Galbois A, Aegerter P, Martel-Samb P et al (2014) Improved prognosis of septic shock in patients with cirrhosis: a multicenter study. Crit Care Med 42(7):1666–1675
Centers for Disease Control and Prevention (1993) Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolsecents and adults. MMWR Morb Mortal Wkly Rep 41:1–19
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349
Thompson MA, Aberg JA, Hoy JF et al (2012) Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 308:387–402
Phair J, Palella F (2011) Renal disease in HIV-infected individuals. Curr Opin HIV AIDS 6:285–289
Sigel K, Wisnivesky J, Gordon K et al (2012) HIV as an independent risk factor for incident lung cancer. AIDS 26:1017–1025
Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5
Morris A, Creasman J, Turner J, Luce JM, Wachter RM, Huang L (2002) Intensive care of human immunodeficiency virus-infected patients during the era of highly active antiretroviral therapy. Am J Respir Crit Care Med 166:262–267
Coquet I, Pavie J, Palmer P et al (2010) Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era. Crit Care 14:R107
Luyt CE, Combes A, Aegerter P et al (2007) Mortality among patients admitted to intensive care units during weekday day shifts compared with “off” hours. Crit Care Med 35:3–11
Zimmerman JE, Kramer AA, McNair DS, Malila FM (2006) Acute physiology and chronic health evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Crit Care Med 34:1297–1310
Akgun KM, Huang L, Morris A, Justice AC, Pisani M, Crothers K (2011) Critical illness in HIV-infected patients in the era of combination antiretroviral therapy. Proc Am Thorac Soc 8:301–307
Zuber B, Tran T-C, Aegerter P et al (2012) Impact of case-volume on survival of septic shock in patients with malignancies. Crit Care Med 40:55–62
Corona A, Raimondi F (2010) Critical care of HIV-infected patients: still a dilemma for Italian intensivists—results of a multicentre survey. Eur J Anaesthesiol 27:377–382
Misset B, Nakache D, Vesin A et al (2008) Reliability of diagnostic coding in intensive care patients. Crit Care 12:R95
Lecuyer L, Chevret S, Guidet B et al (2008) Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 32:748–754
Annane D, Aegerter P, Jars-Guincestre MC, Guidet B (2003) Current epidemiology of septic shock: the CUB-Rea Network. Am J Respir Crit Care Med 168:165–172
Abdool Karim SS, Naidoo, Grobler A et al (2011) Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med 365:1492–1501
Zolopa A, Andersen J, Powderly W et al (2009) Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One 4:e5575
Makadzange AT, Ndhlovu CE, Takarinda K et al (2010) Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in sub-saharan Africa. Clin Infect Dis 50:1532–1538
Meybeck A, Lecomte L, Valette M et al (2012) Should highly active antiretroviral therapy be prescribed in critically ill HIV-infected patients during the ICU stay? A retrospective cohort study. AIDS Res Ther 9:27
Acknowledgments
None.
Conflicts of interest
All authors declare that they have no conflict of interest relevant to the present study.
Author information
Authors and Affiliations
Corresponding author
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.
Electronic supplementary material
Below is the link to the electronic supplementary material.
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).
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-014-3481-7