Current issues in critical care of the human immunodeficiency virus-infected patient.
OBJECTIVE
To provide current information on the epidemiology of human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit during the era of combination antiretroviral therapy and to review issues related to the administration of antiretroviral therapy that are relevant to the intensivist.


METHODS
Review of literature related to intensive care of HIV-infected patients.


RESULTS
Overall mortality of HIV-infected patients in the intensive care unit has decreased in the era of combination antiretroviral therapy, and patients are more commonly admitted with non-HIV-related illnesses. Use of antiretroviral therapy in the intensive care unit is difficult but may be associated with improved outcomes.


CONCLUSIONS
HIV-infected patients are less likely to be admitted to the intensive care unit with opportunistic infections but more likely to be admitted with problems unrelated to HIV infection or with conditions related to antiretroviral therapy. With current management strategies, more patients survive intensive care unit admission. Intensivists need to be familiar with antiretroviral therapy to recognize life-threatening toxicities unique to these drugs; to avoid drug interactions, which are extremely common and potentially life-threatening; and to avoid enhancing HIV drug resistance, an occurrence that could have devastating consequences for the patient following intensive care unit discharge.
Morris
Alison
A
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Masur
Henry
H
Huang
Laurence
L
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents