Richards Guy A, Zamparini Jarrod, Kalla Ismail, Laher Abdullah, Murray Lyle W, Shaddock Erica J, Stacey Sarah, Venter Wd Francois, Feldman Charles
Department of Surgery, Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Lancet HIV. 2024 Jun;11(6):e406-e418. doi: 10.1016/S2352-3018(24)00096-1.
People living with HIV comprise a substantial number of the patients admitted to intensive care. This number varies according to geography, but all areas of the world are affected. In lower-income and middle-income countries, the majority of intensive care unit (ICU) admissions relate to infections, whereas in high-income countries, they often involve HIV-associated non-communicable diseases diagnoses. Management of infections potentially resulting in admission to the ICU in people living with HIV include sepsis, respiratory infections, COVID-19, cytomegalovirus infection, and CNS infections, both opportunistic and non-opportunistic. It is crucial to know which antiretroviral therapy (ART) is appropriate, when is the correct time to administer it, and to be aware of any safety concerns and potential drug interactions with ART. Although ART is necessary for controlling HIV infections, it can also cause difficulties relevant to the ICU such as immune reconstitution inflammatory syndrome, and issues associated with ART administration in patients with gastrointestinal dysfunction on mechanical ventilation. Managing infection in people with HIV in the ICU is complex, requiring collaboration from a multidisciplinary team knowledgeable in both the management of the specific infection and the use of ART. This team should include intensivists, infectious disease specialists, pharmacists, and microbiologists to ensure optimal outcomes for patients.
感染艾滋病毒的人占重症监护病房收治患者的很大一部分。这一数字因地域而异，但世界所有地区都受到影响。在低收入和中等收入国家，重症监护病房（ICU）收治的大多数患者与感染有关，而在高收入国家，收治的患者往往涉及艾滋病毒相关的非传染性疾病诊断。艾滋病毒感染者中可能导致入住ICU的感染的管理包括败血症、呼吸道感染、COVID-19、巨细胞病毒感染以及机会性和非机会性中枢神经系统感染。了解哪种抗逆转录病毒疗法（ART）合适、何时是给药的正确时机，并了解任何安全问题以及与ART的潜在药物相互作用至关重要。虽然ART对于控制艾滋病毒感染是必要的，但它也可能导致与ICU相关的困难，如免疫重建炎症综合征，以及与机械通气的胃肠功能障碍患者的ART给药相关的问题。在ICU中管理艾滋病毒感染者的感染很复杂，需要一个在特定感染管理和ART使用方面都有知识的多学科团队进行协作。这个团队应包括重症监护医生、传染病专家、药剂师和微生物学家，以确保患者获得最佳治疗效果。
