HIV-positive patients in the intensive care unit (original) (raw)
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Critical Care Research and Practice, 2016
In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU. Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference to < 0.05. Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1-1.4, = 0.01)), mechanical ventilation (OR 1.14 (95% CI: 0.09-0.76, = 0.01)), and ARDS (OR 4.5 (95% CI: 1.07-16.7, = 0.04)) had a statistically significant association with mortality. Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.
HIV Medicine, 2019
Compared to other countires internationally, South Africa has the largest number of people living with HIV. There are limited data in developing countries on the outcomes of HIV-infected patients in the intensive care unit (ICU). The objectives of this study were to describe the pattern of presentation of these patients and to determine factors that may influence survival to ICU discharge. Methods The medical charts of 204 consecutive HIV-infected individuals who were admitted to the Charlotte Maxeke Johannesburg Academic Hospital adult general ICU during the calendar year 2017 were retrospectively reviewed. Relevant data were subjected to univariate and multivariate analysis. Results Two-hundred and four (22.6%) out of a total of 903 patients who were admitted to the ICU were HIV positive. Sepsis-related illnesses were the most common reason for ICU admission (n = 95; 46.6%), followed by post-operative care (n = 69; 33.8%) and non-sepsis-related illnesses (n = 40; 19.6%). The median length of stay in the ICU was 5 (interquartile range 2-9) days. ICU mortality was 33.3% (n = 68). On univariate analysis, age (P = 0.039), length of stay in the ICU (P = 0.040), primary diagnostic category (P < 0.05), sepsis acquired during the ICU stay (P = 0.012), inotrope/ vasopressor administration (P < 0.001), mechanical ventilation (P < 0.001), haemodialysis (P = 0.001), CD4 cell count (P = 0.011), Acute Physiology and Chronic Health Assessment (APACHE) II score (P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (P < 0.001) were significantly associated with mortality. Conclusions Age, diagnostic category, sepsis acquired during the ICU stay, inotrope/vasopressor administration, mechanical ventilation, haemodialysis, CD4 cell count, APACHE II score, SOFA score and length of ICU stay were associated with ICU mortality in HIV-infected patients.
Predictors of short-term mortality in HIV-infected patients admitted to Intensive Care Unit
ABCS Health Sciences
Introduction: Historically, complications of HIV infection have been related to admissions to the Intensive Care Unit (ICU). Despite therapeutic advances, the results of the analysis of prognostic factors in patients with HIV/AIDS have varied, including late diagnosis and failure to adhere to antiretroviral treatment. Objective: To evaluate the predictors of short-term mortality in HIV-infected patients admitted to the ICU, as well as their sociodemographic and clinical characteristics. Methods: A retrospective cohort study including patients admitted to the ICU of a teaching hospital from 2003 through 2012. Data were collected from medical records after the Institutional Review Board approval. Results: 148 HIV-infected patients were identified and 131 were eligible. Among included patients, 42.75% were HIV new diagnoses and 5.34% had no information about the time of diagnosis. The main reasons for admission to the ICU were respiratory failure and sepsis while mortality was 70.23% b...
Open Forum Infectious Diseases, 2019
Background The life expectancy of HIV patients has increased with antiretroviral therapy which has reduced the incidence of AIDS-associated illnesses. Longer life expectancy increases noncommunicable diseases cases and the demand for intensive care unit (ICU) care. ICU mortality is higher among HIV patients. Information about mortality and other relevant outcomes among HIV patients from developing countries is paramount for benchmarking purposes. This study aimed to evaluate the mortality of patients with HIV/AIDS admitted to the ICU during the years 1999 to 2015. Methods An observational retrospective study was conducted based on episodes of patients admitted to the ICU of the Fundación Valle del Lili from December 1998 to October 2015. The Cochran-Armitage test was used to evaluate the trend of HIV mortality by 4-year periods, considering sex and age groups ( <50 vs. >50 years). The Z test compared the mortality between HIV patients with non-HIV patients in the ICU; also it ...
Intensive Care Usage by HIV-Positive Patients in the HAART Era
Interdisciplinary perspectives on infectious diseases, 2011
In the 1980s the outlook for patients with the acquired immunodeficiency syndrome (AIDS) and critical illness was poor. Since then several studies of outcome of HIV+ patients on ICU have shown improving prognosis, with anti-retroviral therapy playing a large part. We retrospectively examined intensive care (ICU) admissions in a large HIV unit in London. Between April 2001 and April 2006 43 patients were admitted to the ICU. The mean age of patients was 44 years and 74% were male. Fifty-six percent of admissions were receiving anti-retroviral therapy and 44% had an AIDS defining diagnosis. The median CD4 count was 128 cells/mL and the median APACHE II score was 21. The commonest diagnostic ICU admission category was respiratory disease. This group experienced higher mortality despite slightly lower APACHE II scores, though this did not achieve statistical significance. The follow up period was one year or until April 2007, when data were censored. ICU mortality was 33%, in hospital m...
Mortality, survival and prognostic factors of people with AIDS in intensive care unit
Revista da Escola de Enfermagem da USP, 2021
Objective: To analyze mortality, survival and prognostic factors of patients with AIDS in Intensive Care Unit (ICU). Method: Retrospective cohort study with a sample of 202 patients with AIDS in ICU, whose sociodemographic, epidemiological, and clinical characteristics were obtained from medical records and assessed. Results: Patients were mostly male (73.8%) and drug users (59.4%), with no regular health follow-up (61.4%) and no adherence to antiretrovirals (40.6%), presenting low CD4+ T lymphocyte count (94.0%) and high viral load (44.6%). The main causes of hospitalization were sepsis and respiratory and renal insufficiency. The mean duration of hospitalization was 11.9 days (p = 0.0001), with a 41.6% survival; 58.5% died in the ICU. Sepsis upon admission (p < 0.001), pressure injury (p = 0.038), sexual exposure (p = 0.002), high viral load (p = 0.00001) and prolonged hospitalization (p < 0.001) increased the risk of death. Conclusion: Most patients had no regular health fo...
Background: There is a paucity of data on the mortality of patients admitted to the intensive care unit (ICU), despite the fact that human immunodeficiency virus (HIV)-related diseases represent a significant burden to health care resources particularly in sub-Saharan Africa. Aim: To describe the outcome and prognostic factors of HIV-infected patients requiring mechanical ventilation in an ICU. Design: Prospective observational study. Methods: All 54 patients (34.8 6 10.4 years, 38 females) admitted with confirmed HIV from October 2012 until May 2013 were enrolled. Disease severity was graded according to APACHEII score. Admission diagnoses, clinical features and laboratory investigations, complications and outcomes were recorded. Results: The mean length of ICU stay was 11.0 days (range: 1–49 days), and 33 patients survived (ICU mortality: 38.9%). The in-hospital mortality at 30 days was 48.1%. ICU mortality was associated with an AIDS-defining diagnosis (OR ¼ 7.97, P ¼ 0.003). Non-survivors had higher APACHEII scores (25.8 vs. 18.6, P ¼ 0.001) and lower mean admission CD 4 counts (102.5 vs. 225.2, P ¼ 0.014). Multiple logistical regression analysis confirmed the independent predictive value of WHO stage 4 disease (P ¼ 0.008), lower mean CD 4 count on admission (P ¼ 0.057) and higher APACHEII score (P ¼ 0.010) on ICU mortality, and WHO stage 4 (P ¼ 0.007) and higher APACHE II score (P ¼ 0.003) on 30-day mortality. Conclusions: The ICU mortality of mechanically ventilated HIV-positive patients was high. WHO stage 4 disease and a higher APACHEII score were predictive of both ICU and 30-day mortality, whereas a low CD 4 count on admission was associated with ICU mortality.
Critical Care in Human Immunodeficiency Virus–Infected Patients
Persons living with HIV who have access to antiretroviral therapy (ART) are living longer. HIV-infected patients are at increased risk for developing common comorbidities associated with aging including liver, cardiovascular, renal, and pulmonary diseases. 1–4 These comorbidities are responsible for the majority of hospitalizations and intensive care unit (ICU) admissions for patients with access to ART. However, opportunistic infections (OIs) still account for a significant proportion of ICU admissions due to unknown HIV status, limited access to care, viral resistance, and/or compliance with ART. We review the important shifts in ICU admission diagnosis, risk factors, and outcomes among HIV-infected and how they compare with uninfected patients. We discuss diagnostic and treatment approaches for some of the more common ICU admission diagnoses, focusing on respiratory failure from Pneumocystis jirovecii pneumonia (PCP) and bacterial pneumonia, sepsis, liver disease, and kidney disease. We then discuss immune reconstitution inflammatory syndrome (IRIS) and its treatment as well as the role of ART initiation and continuation for HIV-infected patients admitted to the ICU. The Changing Indications for and Outcomes of ICU Admission among HIV-Infected Patients When HIV infection was first recognized in 1981, the majority of patients were men who had sex with men and were usually in their third to fifth decades of life. HIV-infected patients were frequently admitted to the ICU with OIs such as PCP, toxoplas-mosis, and Cryptococcal meningitis. 5,6 Therapies were limited and in-ICU and in-hospital mortality was between 70 and 90%, with risk especially increased among HIV-infected patients with respiratory failure from PCP. 5–7 Because of the poor outcomes associated with ICU admission, clinicians at that time questioned the utility of this level of care for HIV-infected patients. 8 Keywords ► HIV ► antiretroviral therapy ► outcomes ► opportunistic infections Abstract Intensive care unit (ICU) survival has been improved significantly for HIV-infected patients since the advent of antiretroviral therapy (ART). Non-AIDS conditions account for the majority of ICU admission diagnoses in areas with access to ART. However, opportunistic infections such as Pneumocystis jirovecii pneumonia still account for a significant proportion of ICU admissions, particularly in newly diagnosed HIV-infected patients, and are associated with increased ICU mortality. We discuss risk factors and outcomes for HIV-infected admitted to the ICU in the current ART era. We review the changing patterns in ICU admission diagnoses over time and how common ICU conditions are managed in HIV-infected compared with uninfected patients. We next address issues specific to the care for HIV-infected patients in the ICU, focusing on immune reconstitution inflammatory syndrome, ART continuation or initiation, and some common and potentially life-threatening ART-associated toxicities.