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Critically Ill Patients With HIV: 40 Years Later
Élie Azoulay1, Nathalie de Castro2, François Barbier3
1Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France; ECSTRA, SBIM, and the Saint-Louis Hospital, APHP, Paris, France.
Chest
|August 18, 2019
Summary
Combination antiretroviral therapies (cARTs) have transformed critical care for HIV patients. Critically ill HIV individuals now face non-AIDS events, with significantly reduced mortality rates mirroring those without HIV.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- HIV/AIDS Research
Background:
- Combination antiretroviral therapies (cARTs) have shifted the profile of critically ill HIV-infected patients.
- Most admitted patients are aging with controlled HIV, presenting with non-AIDS-related conditions like bacterial pneumonia and comorbidities.
Purpose of the Study:
- To review current evidence and challenges in managing critically ill HIV-infected patients.
- To highlight the evolution of critical care for this population over nearly 40 years.
Main Methods:
- This is a narrative review.
- It synthesizes existing evidence on the changing landscape of critical care for HIV patients.
Main Results:
- Opportunistic infections are now rare in cART-adherent patients, occurring mainly in those with untreated HIV.
- Key ICU admissions include acute respiratory failure, neurological disorders, sepsis, and increasing rates of liver and kidney diseases.
- Case fatality rates have substantially decreased, approaching those of HIV-uninfected patients.
Conclusions:
- Critical care for HIV patients has improved dramatically due to cART, with outcomes now comparable to HIV-uninfected individuals.
- Management requires updated approaches to diagnostics, cART administration during critical illness, and ethical considerations.
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