Etiologies and outcome of acute respiratory failure in HIV-infected patients.
OBJECTIVE
To assess the etiologies and outcome of acute respiratory failure (ARF) in HIV-infected patients over the first decade of combination antiretroviral therapy (ART) use.


METHODS
Retrospective study of all HIV-infected patients (n = 147) admitted to a single intensive care unit (ICU) for ARF between 1996 and 2006.


RESULTS
ARF revealed the diagnosis of HIV infection in 43 (29.2%) patients. Causes of ARF were bacterial pneumonia (n = 74), Pneumocystis jirovecii pneumonia (PCP, n = 52), other opportunistic infections (n = 19), and noninfectious pulmonary disease (n = 33); the distribution of causes did not change over the 10-year study period. Two or more causes were identified in 33 patients. The 43 patients on ART more frequently had bacterial pneumonia and less frequently had opportunistic infections (P = 0.02). Noninvasive ventilation was needed in 49 patients and endotracheal intubation in 42. Hospital mortality was 19.7%. Factors independently associated with mortality were mechanical ventilation [odds ratio (OR) = 8.48, P < 0.0001], vasopressor use (OR, 4.48; P = 0.03), time from hospital admission to ICU admission (OR, 1.05 per day; P = 0.01), and number of causes (OR, 3.19; P = 0.02). HIV-related variables (CD4 count, viral load, and ART) were not associated with mortality.


CONCLUSIONS
Bacterial pneumonia and PCP remain the leading causes of ARF in HIV-infected patients in the ART era. Hospital survival has improved, and depends on the extent of organ dysfunction rather than on HIV-related characteristics.
Barbier
François
F
Medical ICU and Infectious Disease Department, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
Coquet
Isaline
I
Legriel
Stéphane
S
Pavie
Juliette
J
Darmon
Michael
M
Mayaux
Julien
J
Molina
Jean-Michel
JM
Schlemmer
Benoît
B
Azoulay
Elie
E
D000208:Acute Disease; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies
D044966:Anti-Retroviral Agents