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Intensive Care of Human Immunodeficiency Virus–infected Patients during the Era of Highly Active Antiretroviral Therapy

Department of Medicine, San Francisco General Hospital, University of California, San Francisco; Department of Medicine, University of California, San Francisco, California; and Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Correspondence and requests for reprints should be addressed to Alison Morris, M.D., Division of Pulmonary, Allergy, and Critical Care Medicine, 628 NW Montefiore University Hospital, Pittsburgh, PA 15213. E-mail: morrisam{at}msx.upmc.edu

Highly active antiretroviral therapy for human immunodeficiency virus (HIV) infection has produced significant declines in morbidity and mortality from acquired immunodeficiency syndrome (AIDS). Whether this therapy has resulted in changes in epidemiology and outcomes of intensive care among HIV-infected patients is unknown. We performed chart review of all intensive care unit admissions for HIV-infected patients at San Francisco General Hospital from 1996 through 1999. There were an average of 88.5 admissions per year with 71% survival to hospital discharge. Univariate analysis demonstrated that prior highly active antiretroviral therapy (odds ratio [OR] = 1.8, p = 0.04), a non–AIDS-associated admission diagnosis (OR = 3.7, p = 0.001), a lower Acute Physiology and Chronic Health Evaluation II score (OR = 5.4, p = 0.001), and higher serum albumin (OR = 4.4, p = 0.001) predicted improved survival. Pneumocystis carinii pneumonia (OR = 0.24, p = 0.001), mechanical ventilation (OR = 0.19, p = 0.001), or a pneumothorax (OR = 0.08, p = 0.001) were associated with worse survival. In multivariate logistic regression, all variables except prior use of highly active antiretroviral therapy and pneumothorax were significant independent predictors of outcome. At our institution, overall survival for HIV-infected intensive care unit patients has improved, especially among patients receiving highly active antiretroviral therapy. These patients may have an improved survival because of effects of therapy on variables such as likelihood of non–AIDS-associated admission diagnoses and serum albumin levels.

Key Words: mechanical ventilation • acquired immunodeficiency syndrome • protease inhibitors

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