title: Etiologies and outcome of acute respiratory failure in HIV-infected patients.
abstract: 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.
authors: Medical ICU and Infectious Disease Department, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
authors: François
authors: F
authors: Barbier
authors: Isaline
authors: I
authors: Coquet
authors: Stéphane
authors: S
authors: Legriel
authors: Juliette
authors: J
authors: Pavie
authors: Michael
authors: M
authors: Darmon
authors: Julien
authors: J
authors: Mayaux
authors: Jean-Michel
authors: JM
authors: Molina
authors: Benoît
authors: B
authors: Schlemmer
authors: Elie
authors: E
authors: Azoulay
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents