Admissions to intensive care unit of HIV-infected patients in the era of highly active antiretroviral therapy: etiology and prognostic factors

Medical records of all HIV-infected adults who were admitted to ICU at a university hospital in Taiwan from 2001 to 2010 were reviewed to record information on patient demographics, receipt of HAART, and reason for ICU admission. Factors associated with hospital mortality were analyzed.During the 10-year study period, there were 145 ICU admissions for 135 patients, with respiratory failure being the most common cause (44.4%), followed by sepsis (33.3%) and neurological disease (11.9%). Receipt of HAART was not associated with survival. However, CD4 count was independently predictive of hospital mortality (adjusted odds ratio [AOR], per-10 cells/mm3 decrease, 1.036; 95% confidence interval [CI], 1.003 to 1.069). Admission diagnosis of sepsis was independently associated with hospital mortality (AOR, 2.91; 95% CI, 1.11 to 7.62). A hospital-to-ICU interval of more than 24 hours and serum albumin level (per 1-g/dl decrease) were associated with increased hospital mortality, but did not reach statistical significance in multivariable analysis.Respiratory failure was the leading cause of ICU admissions among HIV-infected patients in Taiwan. Outcome during the ICU stay was associated with CD4 count and the diagnosis of sepsis, but was not associated with HAART in this study.After the introduction of highly active antiretroviral therapy (HAART), the life expectancy of HIV-infected patients has significantly increased and the incidence of illnesses associated with AIDS markedly decreased [1]. Nevertheless, HIV-related complications that may require critical care support continue to occur in HIV-infected patients who are unaware of their HIV serostatus and do not initiate HAART and appropriate antimicrobial prophylaxis, or who fail to respond to HAART with virological and immunologic failures. These patients may also require critical care because of other co-morbidities such as hepatitis co-infections, alcoholism, or chronic obstructive pulmonary disease [2]. Although respira