title: Should highly active antiretroviral therapy be prescribed in critically ill HIV-infected patients during the ICU stay? A retrospective cohort study.
abstract: BACKGROUND
  The impact of highly active antiretroviral therapy (HAART) in HIV-infected patients admitted to the intensive care unit (ICU) remains controversial. We evaluate impact of HAART prescription in HIV-infected patients admitted to the ICU of Tourcoing Hospital from January 2000 to December 2009.
  
  
  RESULTS
  There were 91 admissions concerning 85 HIV-infected patients. Reasons for ICU admission were an AIDS-related diagnosis in 46 cases (51%). Fifty two patients (57%) were on HAART at the time of ICU admission, leading to 21 immunovirologic successes (23%). During the ICU stay, HAART was continued in 29 patients (32%), and started in 3 patients (3%). Only one patient experienced an adverse event related to HAART. Mortality rate in ICU and 6 months after ICU admission were respectively 19% and 27%. Kaplan-Meier estimates of the cumulative unajusted survival probability over 6 months were higher in patients treated with HAART during the ICU stay (Log rank: p = 0.04). No benefit of HAART in ICU was seen in the adjusted survival proportion at 6 months or during ICU stay. Prescription of HAART during ICU was associated with a trend to lower incidence of new AIDS-related events at 6 months (respectively 17% and 34% with and without HAART, p = 0.07), and with higher incidence of antiretroviral resistance after ICU stay (respectively 25% and 7% with and without HAART, p = 0.02).
  
  
  CONCLUSIONS
  Our results suggest a lower death rate over 6 months in critically ill HIV-infected patients taking HAART during ICU stay. The optimal time to prescribe HAART in critically ill patients needs to be better defined.
authors.affiliation: Service de Réanimation et Maladies Infectieuses, Hôpital de Tourcoing, 135 rue du Président Coty, Tourcoing BP 619, France. agnesmeybeck@yahoo.fr.
authors.forename: Agnes
authors.initials: A
authors.lastname: Meybeck
authors.forename: Lydie
authors.initials: L
authors.lastname: Lecomte
authors.forename: Michel
authors.initials: M
authors.lastname: Valette
authors.forename: Nicolas
authors.initials: N
authors.lastname: Van Grunderbeeck
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boussekey
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiche
authors.forename: Hugues
authors.initials: H
authors.lastname: Georges
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy