Critical care of HIV infected patients in the highly active antiretroviral therapy era.
Since there are more than 150 000 Italians (about 25 for every 10,000 inhabitants) infected with HIV, Intensive Care Units (ICU) often come across patients who are HIV positive. The aim of this study was to provide current information on the epidemiology of human immunodeficiency virus (HIV)-infected patients admitted to ICU during the era of highly active antiretroviral therapy (HAART) and to review issues related to the administration of antiretroviral therapy relevant to the ICU staff. Overall mortality of critically ill HIV-infected patients in ICUs has decreased in the HAART era, and patients are more often admitted with non-HIV-related illnesses. Use of HAART in the ICU is difficult; however it may be associated with improved outcomes. More HIV-infected patients survive ICU admission and are less likely to be admitted to the ICU for related infections; in most cases, they need critical care for problems unrelated to HIV infection or for conditions related to HAART toxicity. ICU staff need to be familiar with HAART for the following reasons: 1) to recognize life-threatening toxicities unique to these drugs; 2) to avoid drug interactions, which are extremely common and potentially life-threatening; and 3) to avoid enhancing HIV drug resistance, an occurrence that could have devastating consequences for the patient after discharge from the ICU.
Intensive Care Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy. corona.alberto@libero.it
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D023241:Antiretroviral Therapy, Highly Active / Q000639:trends*; D003422:Critical Care / Q000639:trends*; D015658:HIV Infections / Q000150:complications / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007558:Italy