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

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.