hrvatski

Critically ill HIV/AIDS patients – short and long- term outcomes

Background: HIV/AIDS remains a challenge for intensive care physicians, despite the availability of antiretroviral therapy (ART). Outcomes of patients with HIV treated in the ICU are underinvestigated. Methods: We retrospectively reviewed adult HIV/AIDS patients treated in the ICU, University Hospital for Infectious Diseases, Zagreb, Croatia, from 1996 to 2020. Follow-up was in December 2021. Short-term outcomes included: vital status, length of stay (LOS), and modified Rankin Scale (mRS) at discharge. Long-term outcomes were: vital status, mRS, and ART adherence at follow-up. The favorable functional status was mRS 0-2. Results: Out of 8484 ICU patients, 98 (1.2%) had HIV/AIDS (48.5±11.3 years-old, 83, 90.2% male) For 53 (57.6%), this was inaugural admission, while 39 (44.4%) had previous HIV/AIDS diagnosis (25, 64.1%, adherent to ART). The most common condition (35, 66.0%) in newly diagnosed HIV/AIDS patients was Pneumocystis jirovecii pneumonia, while non- AIDS related events were the most frequent (25, 64.1%) in previously diagnosed patients adherent to ART. Mechanical ventilation was used in 64 (69.6%), VV-ECMO in 8 (8.7%), and continuous renal replacement therapy in 22 (23.9%) patients. ART was administered to 60 (65.2%) patients ; ten (10.9%) had immune reconstitution inflammatory syndrome. There were 48 (52.2%) in-hospital deaths, 44 of which were in the ICU. The median ICU and hospital LOS were 8 (1–143) and 33 (3–232) days, respectively. At discharge, 14 (15.2%) patients had moderate to severe disability (mRS 3- 5), while 30 (32.6%) had favourable functional status. Forty survivors (90.9%) were available for follow-up after a median of 64 (1-230) months. Nine patients (22.5%) were deceased, 7 (17.5%) had moderate to severe disability (mRS 3-5), 28 (70.0%) patients had favourable functional status. All patients available for follow-up were adherent to ART. Conclusion: More than half of critically ill HIV/AIDS patients were newly diagnosed and treated for opportunistic infections. Short-term outcomes were unfavorable, with high mortality and frequent disability. Long-term outcomes for survivors included low mortality and a high favorable functional status rate. All survivors were adherent to ART at follow-up.

Critically ill ; HIV/AIDS ; outcomes

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