Short- and long-term outcome of HIV-infected patients admitted to the intensive care unit

Abstract

The purpose of this investigation was to analyse the impact of the availability of highly active antiretroviral therapy (HAART) on the long-term outcome of human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit (ICU). A retrospective cohort study of HIV-infected patients admitted to the ICU was undertaken. Outcomes in the pre-HAART era (1990-June 1996), early- (July 1996-2002), and recent-HAART (2003-2008) periods and total HAART era (July 1996-2008) were analysed and compared with those reported of the general population. A total of 127 ICU admissions were included. The 1-year mortality decreased from 71% in the pre-HAART era to 50% in the recent-HAART period (p = 0.06). The 5-year mortality decreased from 87% in the pre-HAART era to 59% in the early-HAART period (p = 0.005). Independent predictors of 1-year mortality in the HAART era were age (odds ratio [OR] = 1.16 [95% confidence interval [CI] = 1.06-1.27]), APACHE II score > 20 (6.04 [1.25-29.22]) and mechanical ventilation (40.01 [3.01-532.65]). The 5-year survival after hospitalisation was 80% and in the range of the reported survival of non-HIV-infected patients (83.7%). Predictors of 1-year mortality for HIV patients admitted to the ICU in the HAART era were all non-HIV-related. Short- and long-term outcome has improved since the introduction of HAART and is comparable to the outcome data in non-HIV-infected ICU patients.

Characteristics and Outcomes of HIV-Infected Patients With Severe Sepsis

“…Mortality rates among HIVinfected patients in our institution mirror the rates in the pre-HAART era at other institutions. Independent predictors of mortality have been poor functional status, more than 1 year between HIV diagnosis and ICU admission, age, higher illness severity, low serum albumin, mechanical ventilation, and respiratory failure (17,24,25). This is likely due to a large number of HIV-infected individuals in the Atlanta area who lack access to medical care and health insurance.…”

“…In the ICU, HAART has been associated with a number of predictors for decreased mortality, including higher CD4 count, lower viral load, lower Acute Physiology and Chronic Health Evaluation (APACHE) II score, and higher serum albumin (9). Although survival has improved for individuals living with HIV in the HAART era and some studies suggest that mortality rates are similar to non-HIV patients (10,16,17), optimal outcomes have not been achieved. Studies have shown that up to 50% of HIVinfected patients may not be on HAART at admission to the ICU (2,12).…”

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

“…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…”

The burden of sepsis in critically ill human immunodeficiency virus-infected patients—a brief review

“…27,28 In contrast, in developing settings those figures are lower, reflecting the high rates of late HIV presenters and opportunistic infections commonly seen in those places. 15 Modern ICU standards of care unrelated to HIV therapy (i.e.…”