Akgün Kathleen M, Miller Robert F
Section of Pulmonary, Critical Care and Sleep, Department of Medicine, VA Connecticut, West Haven, CT.
Research Department of Infection and Population Health, University College London, London, United Kingdom.
Semin Respir Crit Care Med. 2016 Apr;37(2):303-17. doi: 10.1055/s-0036-1572561. Epub 2016 Mar 14.
Intensive care unit (ICU) survival has been improved significantly for HIV-infected patients since the advent of antiretroviral therapy (ART). Non-AIDS conditions account for the majority of ICU admission diagnoses in areas with access to ART. However, opportunistic infections such as Pneumocystis jirovecii pneumonia still account for a significant proportion of ICU admissions, particularly in newly diagnosed HIV-infected patients, and are associated with increased ICU mortality. We discuss risk factors and outcomes for HIV-infected admitted to the ICU in the current ART era. We review the changing patterns in ICU admission diagnoses over time and how common ICU conditions are managed in HIV-infected compared with uninfected patients. We next address issues specific to the care for HIV-infected patients in the ICU, focusing on immune reconstitution inflammatory syndrome, ART continuation or initiation, and some common and potentially life-threatening ART-associated toxicities.
自抗逆转录病毒疗法（ART）问世以来，HIV感染患者在重症监护病房（ICU）的生存率有了显著提高。在可获得ART的地区，非艾滋病相关病症占ICU入院诊断的大多数。然而，诸如耶氏肺孢子菌肺炎等机会性感染在ICU入院病例中仍占相当比例，尤其是在新诊断的HIV感染患者中，并且与ICU死亡率增加相关。我们讨论了当前ART时代HIV感染患者入住ICU的危险因素和转归情况。我们回顾了随着时间推移ICU入院诊断的变化模式，以及与未感染患者相比，HIV感染患者常见的ICU病症是如何得到治疗的。接下来，我们将探讨ICU中HIV感染患者护理的特定问题，重点关注免疫重建炎症综合征、ART的继续使用或启动，以及一些常见且可能危及生命的ART相关毒性反应。
