title: Temporal trends in critical events complicating HIV infection: 1999-2010 multicentre cohort study in France.
abstract: OBJECTIVE
  Multicentre data are limited to appraise the management and prognosis of critically ill human immunodeficiency virus (HIV)-infected patients. We sought to describe temporal trends in demographic and clinical characteristics, indications for intensive care and outcome in this patient population.
  
  
  METHODS
  We conducted a cohort study of unselected HIV-infected patients admitted between 1999 and 2010 to 34 French ICUs contributing to the CUB-Réa prospective database.
  
  
  RESULTS
  We included 6,373 consecutive patients. Over the 12-year period, increases occurred in median age (39 years in 1999-2001; 47 years in 2008-2010, p < 0.0001) and prevalence of comorbidities (notably malignancies, from 6.7 to 16.4%, p < 0.0001). Admissions for respiratory failure (39.8% overall), shock (8.1%) and coma (22.7%) decreased (p < 0.0001), while those for sepsis (19.3%) remained stable. The main final diagnoses were bacterial sepsis (24.6%) and non-bacterial acquired immune deficiency syndrome (AIDS)-defining diseases (steady decline from 26.0 to 17.5%, p < 0.0001). Patients increasingly received mechanical ventilation (from 42.9 to 54.0%) and renal replacement therapy (from 9.6 to 16.8%) (p < 0.0001), whereas vasopressor use remained stable (27.4%). ICU readmissions increased after 2004 (p < 0.0001). ICU and hospital mortality (17.6 and 26.9%, respectively) dropped markedly in the most severely ill patients requiring multiple life-sustaining therapies. Malignancies and chronic liver disease were heavily associated with hospital mortality by multivariate analysis, while the most common AIDS-defining complications (Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis and tuberculosis) had no independent impact.
  
  
  CONCLUSIONS
  Progressive ageing, increasing prevalence of comorbidities (mainly malignancies), a steady decline in AIDS-related illnesses and improved benefits from life-sustaining therapies were the main temporal trends in HIV-infected patients requiring ICU admission.
authors.affiliation: Medical Intensive Care Unit (ICU), La Source Hospital, Orléans, France, francois.barbier@chr-orleans.fr.
authors.forename: François
authors.initials: F
authors.lastname: Barbier
authors.forename: Antoine
authors.initials: A
authors.lastname: Roux
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: Patricia
authors.initials: P
authors.lastname: Martel-Samb
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003128:Coma / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D010351:Patient Discharge / Q000639:trends*; D015995:Prevalence; D011378:Prognathism; D000091402:Prohibitins; D011446:Prospective Studies; D012120:Respiration Disorders / Q000453:epidemiology; D018805:Sepsis / Q000453:epidemiology; D012769:Shock / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors