Skip to main content
Springer Nature Link
Log in

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

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. UNAIDS. Executive summary: 2008 report on the global AIDS epidemic. Available online at: http://www.unaids.org/en/dataanalysis/epidemiology/2008reportontheglobalaidsepidemic/

  2. van Leeuwen HJ, Boereboom FT, Pols MA, Hoepelman AI, Savelkoul JT (2000) Factors predicting survival for HIV-infected patients with respiratory failure. Neth J Med 57:74–81

    Article  PubMed  Google Scholar 

  3. Staikowsky F, Lafon B, Guidet B, Denis M, Mayaud C, Offenstadt G (1993) Mechanical ventilation for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. Is the prognosis really improved? Chest 104:756–762

    Article  PubMed  CAS  Google Scholar 

  4. Rogers PL, Lane HC, Henderson DK, Parrillo J, Masur H (1989) Admission of AIDS patients to a medical intensive care unit: causes and outcome. Crit Care Med 17:113–117

    Article  PubMed  CAS  Google Scholar 

  5. Kumar SD, Krieger BP (1998) CD4 lymphocyte counts and mortality in AIDS patients requiring mechanical ventilator support due to Pneumocystis carinii pneumonia. Chest 113:430–433

    Article  PubMed  CAS  Google Scholar 

  6. Nickas G, Wachter RM (2000) Outcomes of intensive care for patients with human immunodeficiency virus infection. Arch Intern Med 160:541–547

    Article  PubMed  CAS  Google Scholar 

  7. Narasimhan M, Posner AJ, DePalo VA, Mayo PH, Rosen MJ (2004) Intensive care in patients with HIV infection in the era of highly active antiretroviral therapy. Chest 125:1800–1804

    Article  PubMed  Google Scholar 

  8. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338:853–860

    Article  PubMed  Google Scholar 

  9. Jensen-Fangel S, Pedersen L, Pedersen C, Larsen CS, Tauris P, Møller A, Sørensen HT, Obel N (2004) Low mortality in HIV-infected patients starting highly active antiretroviral therapy: a comparison with the general population. AIDS 18:89–97

    Article  PubMed  Google Scholar 

  10. Lewden C, Chene G, Morlat P, Raffi F, Dupon M, Dellamonica P, Pellegrin JL, Katlama C, Dabis F, Leport C (2007) HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. J Acquir Immune Defic Syndr 46:72–77

    Article  PubMed  Google Scholar 

  11. Antiretroviral Therapy Cohort Collaboration (2008) Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372:293–299. doi:10.1016/S0140-6736(08)61113-7

    Article  Google Scholar 

  12. Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B (2004) Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS 18:1429–1433

    Article  PubMed  Google Scholar 

  13. Dickson SJ, Batson S, Copas AJ, Edwards SG, Singer M, Miller RF (2007) Survival of HIV-infected patients in the intensive care unit in the era of highly active antiretroviral therapy. Thorax 62:964–968

    Article  PubMed  CAS  Google Scholar 

  14. Powell K, Davis JL, Morris AM, Chi A, Bensley MR, Huang L (2009) Survival for patients with HIV admitted to the ICU continues to improve in the current era of combination antiretroviral therapy. Chest 135:11–17

    Article  PubMed  Google Scholar 

  15. Coquet I, Pavie J, Palmer P, Barbier F, Legriel S, Mayaux J, Molina JM, Schlemmer B, Azoulay E (2010) Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era. Crit Care 14:R107. doi:10.1186/cc9056

    Article  PubMed  Google Scholar 

  16. Palacios R, Hidalgo A, Reina C, de la Torre M, Márquez M, Santos J (2006) Effect of antiretroviral therapy on admissions of HIV-infected patients to an intensive care unit. HIV Med 7:193–196

    Article  PubMed  CAS  Google Scholar 

  17. Morris A, Creasman J, Turner J, Luce JM, Wachter RM, Huang L (2002) Intensive care of human immunodeficiency virus-infected patients during the era of highly active antiretroviral therapy. Am J Respir Crit Care Med 166:262–267

    Article  PubMed  Google Scholar 

  18. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  19. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    Article  PubMed  CAS  Google Scholar 

  20. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA (2006) RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10:R73. doi:10.1186/cc4915

    Article  PubMed  Google Scholar 

  21. [No authors listed] (1992) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 41:1–19

    Google Scholar 

  22. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286:1754–1758

    Article  PubMed  CAS  Google Scholar 

  23. Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, Holmberg SD; HIV Outpatient Study Investigators (2006) Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 43:27–34. doi:10.1097/01.qai.0000233310.90484.16

    Article  PubMed  CAS  Google Scholar 

  24. Croda J, Croda MG, Neves A, De Sousa dos Santos S (2009) Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit. Crit Care Med 37:1605–1611

    Article  PubMed  CAS  Google Scholar 

  25. Niskanen M, Kari A, Halonen P (1996) Five-year survival after intensive care—comparison of 12,180 patients with the general population. Finnish ICU Study Group. Crit Care Med 24:1962–1967

    Article  PubMed  CAS  Google Scholar 

  26. Wright JC, Plenderleith L, Ridley SA (2003) Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642

    Article  PubMed  CAS  Google Scholar 

  27. Williams TA, Dobb GJ, Finn JC, Knuiman MW, Geelhoed E, Lee KY, Webb SA (2008) Determinants of long-term survival after intensive care. Crit Care Med 36:1523–1530

    Article  PubMed  Google Scholar 

  28. Corona A, Raimondi F (2010) Critical care of HIV-infected patients: still a dilemma for Italian intensivists—results of a multicentre survey. Eur J Anaesthesiol 27:377–382

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    S. F. L. van Lelyveld, C. M. Wind, T. Mudrikova & A. I. M. Hoepelman

  2. Department of Dermatology and Venereology, Havenziekenhuis, Rotterdam, The Netherlands

    C. M. Wind

  3. Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    H. J. van Leeuwen

  4. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    D. W. de Lange

Authors
  1. S. F. L. van Lelyveld
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. C. M. Wind
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. T. Mudrikova
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. H. J. van Leeuwen
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. D. W. de Lange
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. A. I. M. Hoepelman
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to S. F. L. van Lelyveld.

Additional information

S.F.L. van Lelyveld and C.M. Wind contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Lelyveld, S.F.L., Wind, C.M., Mudrikova, T. et al. Short- and long-term outcome of HIV-infected patients admitted to the intensive care unit. Eur J Clin Microbiol Infect Dis 30, 1085–1093 (2011). https://doi.org/10.1007/s10096-011-1196-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-011-1196-z

Keywords