Intensive Care of Patients with HIV Infection

Huang, Laurence; Quartin, Andrew A.; Jones, David J.; Havlir, Diane V.

doi:10.1056/nejmra050836

Cited by 161 publications

(141 citation statements)

References 35 publications

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“…Potentially life-threatening and serious adverse events: 3,25 1. Lactic acidosis 3,24 -Although lactic acidosis is uncommon, it has major morbidity and associated mortality. -Lactic acidosis results from mitochondrial toxicity.…”

Section: Systemic and Metabolic Complications Of Arv Drugsmentioning

confidence: 99%

“…Tablets and capsules can be crushed and delivered through the feeding tube. 24 In critical illness, however, the absorption of the ARVs remains a problem 24 due to ileus, decreased gastric motility, frequent suctioning, continuous feeding and stress ulcer prophylaxis. 24 -Gastrostomy: A pilot study conducted by Jennifer King et al 42 suggests that most PIs and NNRTIs can be administered to HIV-infected children via a gastrostomy tube placed surgically.…”

Section: Alternative Routes For Haart Administrationmentioning

confidence: 99%

“…27 Drug delivery, doses, interactions and HAART toxic side effects are a major concern. 24 A decision needs to be taken whether the ARVs should be stopped, continued or whether to switch to another regimen. 27 The exact risk of stopping HAART in the ICU patient is largely unknown, but carries the risk of viral load rebound and drug resistance.…”

Section: Alternative Routes For Haart Administrationmentioning

confidence: 99%

“…Much research is still needed. 24 Poor absorption increases the possibility of resistance to ARV due to poor plasma concentrations. As previously stated, the only IV preparation available is zidovudine and literature on ARV absorption via the nasogastric and jejunal route in the critically ill patient is limited.…”

Section: Alternative Routes For Haart Administrationmentioning

confidence: 99%

“…27 Renal and hepatic impairment play a role in the HAART dose administration. 24 NRTIs must be adjusted during renal impairment. 24 Most of the fixed NRTI combinations cannot be used in renal impairment and must be individualised for a specific patient.…”

Section: Alternative Routes For Haart Administrationmentioning

confidence: 99%

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Antiretroviral therapyand anaesthesia

Schulenburg

Roux

2008

Southern African Journal of Anaesthesia and Analgesia

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HIV has reached pandemic proportions in Southern Africa. Great emphasis is placed on the prevention and containment of HIV transmission by suppressing virus replication using highly active anti-retroviral therapy (HAART). HAART has proven to be highly effective if taken correctly, and has lead to increased life expectancy. Increasing numbers of HIV-positive patients on antiretroviral (ARV) therapy or HIV-exposed individuals taking prophylaxis present for surgery and critical care management. The anaesthesiologist should be familiar with the anaesthetic implications of HIV as well as the possible drug interactions while on ARV treatment. This article focuses specifically on the anaesthetic implications of the patient on HAART.HAART is HIV treatment with a combination of three or more ARV drugs from five broad classes. The specific HAART regimen in use in South Africa is considered in detail in this article. The pharmacokinetics of the ARV drugs is complex, and subject to interactions at many different sites. Serious drug interactions are possible, including drugs commonly used in anaesthesia. Drug interactions and recommendations are discussed in detail.ARVs are known to cause multiple systemic side effects, including lactic acidosis, Immune Reconstitution Inflammatory Syndrome (IRIS), premature atherosclerosis and increased cardiovascular risk, hyperlipidaemia, insulin resistance, skeletal disorders, hepatotoxicity, lipodystrophy, mitochondrial abnormalities, allergic reactions and pancreatitis.Non-compliance is common, and leads to the rapid development of resistance. The anaesthesiologist may inadvertently exacerbate this in the perioperative period. Recommendations regarding the interruption of treatment and fasting are made. Alternative routes for HAART administration are also explored. The management of the critically ill patient on a HAART regimen is discussed.

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Section: Systemic and Metabolic Complications Of Arv Drugsmentioning

confidence: 99%

Section: Alternative Routes For Haart Administrationmentioning

confidence: 99%