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Semin Respir Crit Care Med 2016; 37(02): 303-317
DOI: 10.1055/s-0036-1572561
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Critical Care in Human Immunodeficiency Virus–Infected Patients

Kathleen M. Akgün
1   Section of Pulmonary, Critical Care and Sleep, Department of Medicine, VA Connecticut, West Haven, CT
2   Section of Pulmonary, Critical Care and Sleep, Yale University School of Medicine, New Haven, CT
,
Robert F. Miller
3   Research Department of Infection and Population Health, University College London, London, United Kingdom
4   Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
14 March 2016 (online)

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Abstract

Intensive care unit (ICU) survival has been improved significantly for HIV-infected patients since the advent of antiretroviral therapy (ART). Non-AIDS conditions account for the majority of ICU admission diagnoses in areas with access to ART. However, opportunistic infections such as Pneumocystis jirovecii pneumonia still account for a significant proportion of ICU admissions, particularly in newly diagnosed HIV-infected patients, and are associated with increased ICU mortality. We discuss risk factors and outcomes for HIV-infected admitted to the ICU in the current ART era. We review the changing patterns in ICU admission diagnoses over time and how common ICU conditions are managed in HIV-infected compared with uninfected patients. We next address issues specific to the care for HIV-infected patients in the ICU, focusing on immune reconstitution inflammatory syndrome, ART continuation or initiation, and some common and potentially life-threatening ART-associated toxicities.

Keywords

HIV - antiretroviral therapy - outcomes - opportunistic infections
 

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