Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit

Abstract

Several studies found increased survival times and decreased hospitalization rates since the introduction of highly active antiretroviral therapy (HAART). To examine the impact of HAART on admission patterns and survival of HIV-infected patients admitted to an intensive care unit (ICU). Prospective observational cohort study. All HIV-infected patients admitted from 1 January 1995 to 30 June 1999, to an infectious diseases ICU located in Paris. ICU utilization and admission patterns, and survival. A total of 426 HIV-related admissions were included. Sepsis increased from 16.3% to 22.6% from the pre- to the post-HAART era, whereas AIDS-related admissions decreased from 57.7% to 37% (P 40, Omega score > 75 and mechanical ventilation; and long-term survival with admission in the HAART era and AIDS at ICU admission. Cumulative survival rates after ICU discharge were 85.3% and 70.8% after 12 and 24 months, respectively. HAART had little impact on ICU utilization by HIV-infected patients. After the introduction of HAART AIDS-related conditions decreased and sepsis increased as reasons for ICU admission. Whereas ICU survival was dependent on usual prognostic markers, long-term survival was clearly dependent on HIV disease stage and HAART availability. In both study periods, at least a half of the HIV infected patients were not on anti-retroviral treatment at the time of ICU admission.