Intensive Care in Patients With HIV Infection in the Era of Highly Active Antiretroviral Therapy

doi:10.1378/chest.125.5.1800

Chest

Volume 125, Issue 5, May 2004, Pages 1800-1804

https://doi.org/10.1378/chest.125.5.1800 Get rights and content

Study objectives

The use of highly active antiretroviral therapy (HAART) has dramatically improved morbidity and mortality in patients with HIV infection. The types of critical illness and their outcomes in HIV-infected patients in recent years is unknown.

Design

We reviewed the medical records of all patients admitted to the Medical ICU of Beth Israel Medical Center, NY, from January to June 2001 and compared their characteristics with patients admitted to the same unit from November 1991 to October 1992.

Results

Of 441 admissions in the first half of 2001, 63 admissions (14%) were in 53 HIV-seropositive patients. There were 65 admissions to the Medical ICU during the 1-year period spanning 1991 to 1992. Compared with the earlier period, the 2001 patients were more likely to be black (52% vs 26%, respectively; p < 0.01) and injection drug users (75% vs 48%, respectively; p < 0.01), and were less likely to be white (11% vs 23%, respectively; difference not significant) and homosexual men (6% vs 26%, respectively; p < 0.01). In 2001, patients were less likely to be admitted with respiratory failure (22% vs 54%, respectively; p < 0.01) and with Pneumocystis jiroveci pneumonia (formerly referred to as Pneumocystis carinii) [3% vs 34%, respectively; p < 0.001], and were more likely to be admitted with non-HIV-related diseases (67% vs 12%, respectively; p < 0.001). Overall survival was much higher in the later period (71% vs 49%, respectively; p < 0.01).

Conclusions

In the era of HAART, more patients with HIV infection were admitted to the ICU over a 12-month period than were 10 years previously. Patients were more likely to be injection drug users and were more likely to be admitted to the ICU because of non-HIV-associated conditions.

Section snippets

Materials and Methods

This study was approved by the Beth Israel Medical Center Institutional Review Board. All patients admitted to the Medical ICU were studied prospectively from January through June 2001 (ie, the post-HAART era), and their characteristics were compared with those of patients admitted to the same unit from November 1991 through October 1992 (ie, the pre-HAART era), which were published previously.³ Beth Israel Medical Center is an 847-bed, urban, acute care hospital and has been a designated AIDS

Results

During the 6-month study period, there were 441 admissions to the ICU. In all, 96 patients with HIV were admitted to the ICU over a 1-year period, starting October 2000. In the 6-month period of intensive prospective review, 53 HIV-seropositive patients had a total of 63 ICU admissions (14% of all admissions). This group was compared to 65 different patients admitted to the same ICU during the same 1-year period approximately 10 years earlier. The characteristics of the patients admitted to the

Discussion

Before HAART became the standard of care, most patients with HIV infection had progressive immune compromise and eventually succumbed to opportunistic infection, AIDS-associated malignancy, or HIV-associated dementia and wasting. Questions about whether to provide intensive care were inevitable, and the medical literature described the incidences and outcomes of the critical illnesses that HIV-infected persons developed. With the use of HAART, HIV-infected persons enjoyed a reduced risk of

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Subjects were enrolled between 2006 and 2012. Baseline patient demographics, comorbidities, illness severity, causes of ARDS, and clinical outcomes were obtained. The primary end point was hospital mortality.
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Since the advent of highly active antiretroviral therapy in 1996, we have seen dramatic changes in morbi-mortality rates from human immunodeficiency virus-positive patients. If on the one hand, the immunologic preservation-associated with the use of current antiretroviral therapy markedly diminishes the incidence of opportunistic infections, on the other hand it extended life expectancy of human immunodeficiency virus-infected individuals similarly to the general population. However, the management of critically ill human immunodeficiency virus-infected patients remains challenging and troublesome for practicing clinician. Sepsis – a complex systemic inflammatory syndrome in response to infection – is the second leading cause of intensive care unit admission in both human immunodeficiency virus-infected and uninfected populations. Recent data have emerged describing a substantial burden of sepsis in the infected population, in addition, to a much poorer prognosis in this group. Many factors contribute to this outcome, including specific etiologies, patterns of inflammation, underlying immune dysregulation related to chronic human immunodeficiency virus infection and delays in prompt diagnosis and treatment. This brief review explores the impact of sepsis in the context of human immunodeficiency virus infection, and proposes future directions for better management and prevention of human immunodeficiency virus-associated sepsis.
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: Supported by a grant from the Alan & Barbara Mirken Pulmonary Fund.

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Clinical Investigations in Critical CareIntensive Care in Patients With HIV Infection in the Era of Highly Active Antiretroviral Therapy

Study objectives

Design

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Chest

Crit Care Clin

HIV/AIDS surveillance report

MMWR Morb Mortal Wkly Rep

Intensive care of human immunodeficiency virus-infected patients during the era of highly active antiretroviral therapy

Am J Respir Crit Care Med

Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents

Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection: the HIV Outpatient Study Investigators

N Engl J Med

Clinical Investigations in Critical Care
Intensive Care in Patients With HIV Infection in the Era of Highly Active Antiretroviral Therapy