Survival for patients With HIV admitted to the ICU continues to improve in the current era of combination antiretroviral therapy.
BACKGROUND
The combination antiretroviral therapy (ART) era (1996 to the present) has been associated with improved survival among HIV-infected outpatients, but ICU data from 2000 to the present are limited.


METHODS
We conducted a retrospective study of HIV-infected adults who had been admitted to the ICU at San Francisco General Hospital (from 2000 to 2004). The primary outcome was survival to hospital discharge.


RESULTS
During the 5-year study period, there were 311 ICU admissions for 281 patients. Respiratory failure remained the most common indication for ICU admission (42% overall), but the proportion of patients with respiratory failure decreased each year from 52 to 34% (p = 0.02). Hospital survival ratios significantly increased during the 5-year period (p = 0.001). ART use at ICU admission was not associated with survival, but it was associated with higher CD4 cell counts, lower plasma HIV RNA levels, higher serum albumin levels, and lower proportions with AIDS-associated ICU admission diagnoses and with Pneumocystis pneumonia. In a multivariate analysis, a higher serum albumin level (adjusted odds ratio [AOR], 2.08; 95% confidence interval [CI], 1.41 to 3.06; p = 0.002) and the absence of mechanical ventilation (AOR, 6.11; 95% CI, 2.73 to 13.72; p < 0.001) were associated with survival.


CONCLUSIONS
In this sixth in a series of consecutive studies started in 1981, we found that the epidemiology of ICU admission diagnoses continues to change. Our study also found that survival for critically ill HIV-infected patients continues to improve in the current era of ART. Although ART use was not associated with survival, it was associated with predictors that were associated with survival in a multivariate analysis.
Powell
Krista
K
Department of Medicine, University of California San Francisco, San Francisco, CA. Electronic address: kpow05@gmail.com.
Davis
J Lucian
JL
Department of Medicine, University of California San Francisco, San Francisco, CA.
Morris
Alison M
AM
Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Chi
Amy
A
Division of Pulmonary and Critical Care Medicine, Boston University, Boston, MA.
Bensley
Matthew R
MR
HIV/AIDS Division, San Francisco General Hospital, San Francisco, CA.
Huang
Laurence
L
Department of Medicine, University of California San Francisco, San Francisco, CA.
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco; D015996:Survival Rate; D055815:Young Adult
D044966:Anti-Retroviral Agents