Outcomes for critically ill patients with HIV and severe sepsis in the era of highly active antiretroviral therapy.
BACKGROUND
With the advent of highly active antiretroviral therapy (HAART), sepsis has become a more frequent ICU diagnosis for patients with HIV infections. Yet, little is known about the etiologies of acute infections in critically ill patients with HIV and the factors that affect in-hospital mortality.


METHODS
Cases of patients with HIV requiring intensive care specifically for severe sepsis were identified over 27 months. Demographic information, variables related to acute illness severity, variables related to HIV infection, and all acute infections contributing to ICU stay were recorded.


RESULTS
Of 990 patients admitted to the ICU with severe sepsis, 136 (13.7%) were HIV-infected. There were 194 acute infections among the 125 patients with full data available; 112 of the infections were nosocomial/health care-associated, 55 were AIDS-related, and 27 were community-acquired. Patients with nosocomial/health care-associated and AIDS-related infections had lower CD4 counts and were less likely to be on HAART (P < .05). The inpatient mortality was 42%. In a multivariable logistic regression model, only the APACHE II score (odds ratio, 1.12; 95% confidence interval, 1.02-1.23) was significantly associated with hospital mortality, although any HAART use (odds ratio, 0.53; 95% confidence interval, 0.22-1.33, P = .18) approached statistical significance.


CONCLUSIONS
In this large cohort study, nosocomial/health care-associated infections were common in ICU patients with HIV and severe sepsis. Hospital mortality was associated with acute illness severity, but not clearly associated with variables related to HIV infection. Interventions that aim to prevent or more effectively treat nosocomial infections in critically ill patients with HIV may favorably impact clinical outcomes.
Department of Medicine, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA 30303, USA. jaredagreenberg@gmail.com
Jared A
JA
Greenberg
Jeffrey L
JL
Lennox
Greg S
GS
Martin
D000208:Acute Disease; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D017714:Community-Acquired Infections / Q000453:epidemiology; D016638:Critical Illness; D003428:Cross Infection / Q000209:etiology* / Q000401:mortality; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome