Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2011 Sep;30(9):1085-93. doi: 10.1007/s10096-011-1196-z. Epub 2011 Feb 18.
The purpose of this investigation was to analyse the impact of the availability of highly active antiretroviral therapy (HAART) on the long-term outcome of human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit (ICU). A retrospective cohort study of HIV-infected patients admitted to the ICU was undertaken. Outcomes in the pre-HAART era (1990-June 1996), early- (July 1996-2002), and recent-HAART (2003-2008) periods and total HAART era (July 1996-2008) were analysed and compared with those reported of the general population. A total of 127 ICU admissions were included. The 1-year mortality decreased from 71% in the pre-HAART era to 50% in the recent-HAART period (p = 0.06). The 5-year mortality decreased from 87% in the pre-HAART era to 59% in the early-HAART period (p = 0.005). Independent predictors of 1-year mortality in the HAART era were age (odds ratio [OR] = 1.16 [95% confidence interval [CI] = 1.06-1.27]), APACHE II score > 20 (6.04 [1.25-29.22]) and mechanical ventilation (40.01 [3.01-532.65]). The 5-year survival after hospitalisation was 80% and in the range of the reported survival of non-HIV-infected patients (83.7%). Predictors of 1-year mortality for HIV patients admitted to the ICU in the HAART era were all non-HIV-related. Short- and long-term outcome has improved since the introduction of HAART and is comparable to the outcome data in non-HIV-infected ICU patients.
本研究旨在分析高效抗逆转录病毒治疗（HAART）的可及性对重症监护病房（ICU）收治的人类免疫缺陷病毒（HIV）感染患者的长期预后的影响。我们对 ICU 收治的 HIV 感染患者进行了回顾性队列研究。分析并比较了在 HAART 前（1990 年 6 月 1996 年）、早期（1996 年 7 月-2002 年）和近期（2003 年-2008 年）HAART 以及总 HAART 时期（1996 年 7 月-2008 年）的结果，并与一般人群的报告结果进行比较。共纳入 127 例 ICU 入住患者。1 年死亡率从 HAART 前的 71%降至近期 HAART 期的 50%（p=0.06）。5 年死亡率从 HAART 前的 87%降至早期 HAART 期的 59%（p=0.005）。HAART 时代 1 年死亡率的独立预测因素为年龄（优势比[OR] = 1.16[95%置信区间[CI] = 1.06-1.27]）、APACHE II 评分>20（6.04[1.25-29.22]）和机械通气（40.01[3.01-532.65]）。住院后 5 年生存率为 80%，与非 HIV 感染患者的报告生存率（83.7%）相当。HAART 时代 ICU 收治 HIV 患者 1 年死亡率的预测因素均与 HIV 无关。自 HAART 引入以来，短期和长期预后均有所改善，与非 HIV 感染 ICU 患者的预后数据相当。
