title: Characteristics and outcomes of HIV-1-infected patients with acute respiratory distress syndrome.
abstract: OBJECTIVE
  We determined the prevalence of risk factors for the development of acute respiratory distress syndrome (ARDS), outcomes of critical illness, and the impact of highly active antiretroviral therapy in HIV-1-infected patients. We hypothesized that in an urban county hospital, HIV-1-infected patients with ARDS would have a higher mortality than their HIV-1-uninfected counterparts.
  
  
  METHODS
  Subjects were enrolled between 2006 and 2012. Baseline patient demographics, comorbidities, illness severity, causes of ARDS, and clinical outcomes were obtained. The primary end point was hospital mortality.
  
  
  RESULTS
  A total of 178 subjects with ARDS were enrolled in the study; 40 (22%) were infected with HIV-1. The median CD4 count was 75 (15.3-198.3), and 25% were on highly active antiretroviral therapy. HIV-1-infected subjects were significantly younger (44 vs 52 years; P < .01) and had higher rates of asthma, chronic obstructive pulmonary disease, pneumonia, history of hospital-acquired infections, and prior sepsis. HIV-1-infected subjects had greater illness severity by Acute Physiology and Chronic Health Evaluation II scores (29 [24-31] vs 24 [22-25]; P < .01). Hospital mortality was not higher among HIV-1-infected subjects compared with HIV-1-uninfected subjects (50.0% vs 38.4%; P = .19).
  
  
  CONCLUSIONS
  In patients with ARDS, HIV-1 infection was associated with greater illness severity but was not associated with higher mortality in ARDS. Future studies need to be done to evaluate the factors that contribute to high morbidity and mortality in medically vulnerable populations who develop ARDS.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai University, New York, NY. Electronic address: freny.nirappil@mountsinai.org.
authors.forename: Freny J
authors.initials: FJ
authors.lastname: Nirappil
authors.affiliation: Department of Internal Medicine, Mercy Catholic Medical Center, Philadelphia, PA.
authors.forename: Ana
authors.initials: A
authors.lastname: Maheshwari
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA.
authors.forename: Joel
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Esper
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA; Pulmonary Medicine, Department of Veterans Affairs Medical Center, Atlanta, GA.
authors.forename: Sushma K
authors.initials: SK
authors.lastname: Cribbs
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D001249:Asthma / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015497:HIV-1; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors
keywords: Acute respiratory distress syndrome; Antiretroviral therapy; Critical illness; Human immunodeficiency virus; Medically vulnerable