Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Abstract

Objective To evaluate the impact of antiretroviral therapy (ART) and the prognostic factors for in-intensive care unit (ICU) and 6-month mortality in human immunodeficiency virus (HIV)-infected patients. Design A retrospective cohort study was conducted in patients admitted to the ICU from 1996 through 2006. The follow-up period extended for 6 months after ICU admission. Setting The ICU of a tertiary-care teaching hospital at the Universidade de São Paulo, Brazil. Participants A total of 278 HIV-infected patients admitted to the ICU were selected. We excluded ICU readmissions (37), ICU admissions who stayed less than 24 hours (44), and patients with unavailable medical charts (36). Outcome Measure In-ICU and 6-month mortality. Main Results Multivariate logistic regression analysis and Cox proportional hazards models demonstrated that the variables associated with in-ICU and 6-month mortality were sepsis as the cause of admission (odds ratio [OR] = 3.16 [95% confidence interval [CI] 1.65– 6.06]); hazards ratio [HR] = 1.37 [95% CI 1.01–1.88]), an Acute Physiology and Chronic Health Evaluation II score > 19 [OR = 2.81 (95% CI 1.57–5.04); HR = 2.18 (95% CI 1.62–2.94)], mechanical ventilation during the first 24 hours [OR = 3.92 (95% CI 2.20–6.96); HR = 2.25 (95% CI 1.65–3.07)], and year of ICU admission [OR = 0.90 (95% CI 0.81– 0.99); HR = 0.92 [95% CI 0.87– 0.97)]. CD4 T-cell count <50 cells/mm3 was only associated with ICU mortality [OR = 2.10 (95% CI 1.17– 3.76)]. The use of ART in the ICU was negatively predictive of 6-month mortality in the Cox model [HR = 0.50 (95% CI 0.35– 0.71)], especially if this therapy was introduced during the first 4 days of admission to the ICU [HR = 0.58 (95% CI 0.41– 0.83)]. Regarding HIV-infected patients admitted to ICU without using ART, those who have started this treatment during ICU stay presented a better prognosis when time and potential confounding factors were adjusted for [HR 0.55 (95% CI 0.31– 0.98)]. Conclusions The ICU outcome of HIV-infected patients seems to be dependent not only on acute illness severity, but also on the administration of antiretroviral treatment. (Crit Care Med 2009; 37: 000–000)

Mortality of patients infected with HIV in the intensive care unit (2005-2010): significant role of chronic hepatitis C and severe sepsis

“…A continual shift occurred toward ICU admissions for non-AIDS-related diagnoses [4]. Among them, sepsis has been responsible for about 12% to 31% of HIV-infected patient admissions to the ICU, and is associated with a worse prognosis [11,36,37]. In our study, we found that HIV-infected patients had a higher frequency of opportunistic infections than did patients in the control group; despite being in the late period of cART.…”

“…However, specific HIV characteristics (CD4 cell count, plasma HIV-RNA load, HIV-related diagnosis, or antiretroviral therapy) have not been clearly identified as predictors of ICU mortality [4,15,37,38,[49][50][51][52][54][55][56][57][58][59], although some reports have associated CD4…”

Pacientes con infección por VIH/SIDA en una Unidad de Pacientes Críticos: La experiencia de un hospital general en un país en desarrollo

“…Desde la vereda opuesta, una mortalidad hospitalaria de 25% con una sobrevida que se estabiliza a los 18 meses indica que los esfuerzos terapéuticos con estos pacientes se justifican no sólo en el cuadro agudo sino que para los años venideros. Por otra parte, la declinación progresiva de la mortalidad en UCI observada en países desarrollados 22 , el impacto beneficioso aparente de una TARGA precoz 26 y la estabilización del riesgo de muerte luego del egreso como se observó en este trabajo, son argumentos que justifican el ingreso de estos pacientes a una UCI a pesar del rechazo de algunos equipos médicos para adoptar tal medida 27 . Un paciente falleció pocas horas después de recibir su primera dosis de TARGA con abacavir-lamivudinaefavirenz, en un cuadro compatible con una reacción de hipersensibilidad a abacavir o lamivudina y que cursó con hipotensión arterial y exantema.…”

“…Un estudio retrospectivo indicó que la mortalidad en pacientes con neumonía por P. jiroveci se redujo significativamente en aquellos pacientes que mantienen o inician su terapia en UCI 32 . Un estudio en Brasil detectó que el inicio o continuación de TARGA se asoció junto a otras variables independientes, a un menor riesgo de morir a los 6 meses de ingresar a una UCI (hazard ratio 0,5) y además observó que este efecto protector está ligado al inicio de TARGA en los primeros cuatro días de ingreso a UCI 26 . En la misma línea, en Francia el inicio o continuación de TARGA fue un factor ligado a una menor mortalidad en UCI (odds ratio 0,28) y el inicio del TARGA a una menor mortalidad a los seis meses de seguimiento (OR 0,17) 33 .…”

Uso de albumina humana em pacientes graves: controvérsias e recomendações

“…For example, serum albumin is an independent marker of morbidity and mortality in patients with acute acquired immunodeficiency syndrome (AIDS) admitted to the ICU. (21) In this population, the serum albumin level is a marker for the nutritional deficiency that may influence prognosis. However, the effect of albumin therapy in certain AIDS-associated conditions, such as acute respiratory failure and sepsis, has not been evaluated.…”