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

Abstract

Background: Several studies found increased survival times and decreased hospitalization rates since the introduction of highly active antiretroviral therapy (HAART).

Objective: To examine the impact of HAART on admission patterns and survival of HIV-infected patients admitted to an intensive care unit (ICU).

Design: Prospective observational cohort study.

Setting and subjects: All HIV-infected patients admitted from 1 January 1995 to 30 June 1999, to an infectious diseases ICU located in Paris.

Main outcome measures: ICU utilization and admission patterns, and survival.

Results: 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 < 0.05). No significant difference in ICU utilization was found. In both periods, half of the patients were not on antiretroviral treatment at ICU admission. In-ICU mortality was 23%, without significant difference between the study periods. By multivariable analysis, in-ICU mortality was significantly associated with SAPS II > 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.

Conclusions: 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.