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Intensive Care Medicine

, Volume 30, Issue 5, pp 859–866 | Cite as

Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era

  • Benoît Vincent
  • Jean-François TimsitEmail author
  • Marc Auburtin
  • Frédérique Schortgen
  • Lila Bouadma
  • Michel Wolff
  • Bernard Regnier
Original

Abstract

Objective

To examine whether the introduction of highly active antiretroviral therapy (HAART) has changed the rate of admission, the clinical spectrum, and the mortality of HIV-infected ICU patients.

Design

Observational study.

Setting

Infectious diseases ICU in a teaching hospital, Paris, France.

Patients

All HIV-infected patients admitted during a pre-HAART era (1995–1996; n=189) and a HAART era (1998–2000; n=236).

Interventions

None.

Measurements and results

At the HAART era, 79% of patients had derived no or little benefit from the availability of HAART at ICU admission: 44% had no history of antiretroviral (ARV) medications and 35% had failed to respond to ARV. As compared with the pre-HAART era, the rate of hospitalized HIV-infected patients requiring the ICU stay increased (HAART, 5.9% vs pre-HAART, 4.4%; p=0.004). The admission was more likely to occur through the emergency room (45 vs 29%, p=0.0004), and the patients to be foreigners (38.1 vs 28.6%; p=0.04). After adjustment for significant prognostic covariates (AIDS-related tumors at admission, CD4 count <50/mm3, poor functional status (Knaus score C or D), SAPSII, and need for mechanical ventilation), ICU survival was unchanged (adjusted OR=0.613, 95% CI=0.312–1.206), but 3-month survival was significantly improved (adjusted OR=0.57; 95% CI=0.32–0.99; p=0.045).

Conclusion

The number of HIV-infected patients admitted to the ICU remained high in the HAART era. Underutilization of HAART and limited access to health care are possible explanations. The ICU mortality has remained unchanged, but 3-month mortality has decreased.

Keywords

ICU mortality Post-ICU mortality AIDS HAART 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Benoît Vincent
    • 1
  • Jean-François Timsit
    • 1
    Email author
  • Marc Auburtin
    • 1
  • Frédérique Schortgen
    • 1
  • Lila Bouadma
    • 1
  • Michel Wolff
    • 1
  • Bernard Regnier
    • 1
  1. 1.Medical and Infectious Diseases Intensive Care UnitBichat-Claude Bernard University HospitalParis cedex 18France

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