title: Neurological complications of HIV infection in critically ill patients: clinical features and outcomes.
abstract: OBJECTIVE
  We aimed to investigate the prognosis of HIV-infected patients with acute neurological complications at the highly active antiretroviral therapy (HAART) era.
  
  
  METHODS
  We performed a retrospective study in HIV-infected patients admitted to a medical ICU with neurological complications between 2001 and 2008.
  
  
  RESULTS
  Among the 210 studied patients (median [interquartile range] CD4-cell count: 80 [18-254]/μL; HIV viral load: 4.8 [2-5.3] log₁₀/mL), 40 (19%) had unknown HIV status at admission. Neurological complications consisted in delirium (45%), coma (39%), seizures (32%) and/or intracranial hypertension (21%). Admission diagnoses were AIDS-defining CNS disease for 88 (42%) patients, non-AIDS-defining CNS disease for 45 (21%), and systemic disease with neurological signs for 77 (37%). Seizures (p=0.003), focal deficit (p<0.001) and intracranial hypertension (p<0.001) were more frequently observed in patients with AIDS-defining CNS disease. Factors independently associated with ICU mortality (29.5%) were intracranial hypertension [odds ratio (OR), 5.09; 95% confidence interval (95% CI), 2.17-11.91], vasopressor use [OR, 3.92; 95% CI, 1.78-8.60] and SAPS II score [per 10-point increment, OR, 1.59; 95% CI, 1.31-1.93].
  
  
  CONCLUSIONS
  Prognosis of HIV-infected patients with neurological complications depends rather on clinical presentation than on HIV-related parameters. Intracranial hypertension symptoms at admission have a major impact on outcome.
authors.affiliation: Department of Critical Care Medicine and Infectious Diseases, Bichat-Claude-Bernard University Hospital, Université Paris 7-Denis Diderot, AP-HP, 46 Rue Henri Huchard, 75877 Paris Cedex, France. romain.sonneville@bch.aphp.fr
authors.forename: R
authors.initials: R
authors.lastname: Sonneville
authors.forename: H
authors.initials: H
authors.lastname: Ferrand
authors.forename: F
authors.initials: F
authors.lastname: Tubach
authors.forename: C
authors.initials: C
authors.lastname: Roy
authors.forename: L
authors.initials: L
authors.lastname: Bouadma
authors.forename: I F
authors.initials: IF
authors.lastname: Klein
authors.forename: A
authors.initials: A
authors.lastname: Foucrier
authors.forename: B
authors.initials: B
authors.lastname: Regnier
authors.forename: B
authors.initials: B
authors.lastname: Mourvillier
authors.forename: M
authors.initials: M
authors.lastname: Wolff
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis / Q000503:physiopathology*; D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000503:physiopathology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology*; D003128:Coma / Q000175:diagnosis; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012640:Seizures / Q000175:diagnosis