Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France.
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Intensive Care Med. 2020 Feb;46(2):329-342. doi: 10.1007/s00134-020-05945-3. Epub 2020 Feb 3.
The widespread use of combination antiretroviral therapies (cART) has converted the prognosis of HIV infection from a rapidly progressive and ultimately fatal disease to a chronic condition with limited impact on life expectancy. Yet, HIV-infected patients remain at high risk for critical illness due to the occurrence of severe opportunistic infections in those with advanced immunosuppression (i.e., inaugural admissions or limited access to cART), a pronounced susceptibility to bacterial sepsis and tuberculosis at every stage of HIV infection, and a rising prevalence of underlying comorbidities such as chronic obstructive pulmonary diseases, atherosclerosis or non-AIDS-defining neoplasms in cART-treated patients aging with controlled viral replication. Several patterns of intensive care have markedly evolved in this patient population over the late cART era, including a steady decline in AIDS-related admissions, an opposite trend in admissions for exacerbated comorbidities, the emergence of additional drivers of immunosuppression (e.g., anti-neoplastic chemotherapy or solid organ transplantation), the management of cART in the acute phase of critical illness, and a dramatic progress in short-term survival that mainly results from general advances in intensive care practices. Besides, there is a lack of data regarding other features of ICU and post-ICU care in these patients, especially on the impact of sociological factors on clinical presentation and prognosis, the optimal timing of cART introduction in AIDS-related admissions, determinants of end-of-life decisions, long-term survival, and functional outcomes. In this narrative review, we sought to depict the current evidence regarding the management of HIV-infected patients admitted to the intensive care unit.
广泛使用联合抗逆转录病毒疗法（cART）已经将 HIV 感染的预后从快速进展和最终致命的疾病转变为一种对预期寿命影响有限的慢性疾病。然而，由于严重机会性感染的发生，HIV 感染者仍然面临严重疾病的高风险，这些感染发生在免疫抑制程度较高的患者中（即首次入院或 cART 治疗受限），在 HIV 感染的每个阶段都存在明显的细菌败血症和结核病易感性，以及在接受 cART 治疗的控制病毒复制的患者中，潜在合并症（如慢性阻塞性肺疾病、动脉粥样硬化或非艾滋病定义性肿瘤）的患病率不断上升。在晚期 cART 时代，这一患者群体的重症监护模式发生了显著变化，包括 AIDS 相关入院人数稳步下降，合并症恶化的入院人数呈相反趋势，免疫抑制的其他驱动因素出现（例如，抗肿瘤化疗或实体器官移植），cART 在危重病急性阶段的管理，以及短期生存率的显著提高，这主要是由于重症监护实践的普遍进步。此外，这些患者的 ICU 和 ICU 后护理的其他特征缺乏数据，特别是社会学因素对临床表现和预后的影响、AIDS 相关入院时 cART 引入的最佳时机、临终决策、长期生存和功能结果的决定因素。在这篇叙述性综述中，我们试图描述目前关于入住重症监护病房的 HIV 感染者管理的证据。
