title: Characteristics and Outcomes of HIV-Infected Patients With Severe Sepsis: Continued Risk in the Post-Highly Active Antiretroviral Therapy Era.
abstract: OBJECTIVE
  Although highly active antiretroviral therapy has led to improved survival in HIV-infected individuals, outcomes for HIV-infected patients with sepsis in the post-highly active antiretroviral therapy era are conflicting. Access to highly active antiretroviral therapy and healthcare disparities continue to affect outcomes. We hypothesized that HIV-infected patients with severe sepsis would have worse outcomes compared with their HIV-uninfected counterparts in a large safety-net hospital where access to healthcare is low and delivery of critical care is delayed.
  
  
  METHODS
  Secondary analysis of an ongoing prospective observational study between 2006 and 2010.
  
  
  METHODS
  Three adult ICUs (medical ICU, surgical ICU, and neurologic ICU) at Grady Memorial Hospital, Atlanta, GA.
  
  
  METHODS
  Adult patients with severe sepsis in the ICU.
  
  
  METHODS
  Baseline patient characteristics and clinical outcomes were collected. HIV-infected and HIV-uninfected patients with sepsis were compared using t tests, chi-square tests, and logistic regression; p values less than 0.05 indicated significance.
  
  
  RESULTS
  Of 1,095 patients with severe sepsis enrolled, 165 (15%) were positive for HIV, with a median CD4 count of 41 (8-167). Twenty-two percent of HIV-infected patients were on highly active antiretroviral therapy prior to admission, and 80% had a CD4 count less than 200. HIV-infected patients had a greater hospital mortality (50% vs 38%; p < 0.01). HIV infection (odds ratio = 1.78; p = 0.005) was an independent predictor of mortality by multivariate regression modeling after adjusting for age, history of pneumonia, history of hospital-acquired infection, and history of sepsis.
  
  
  CONCLUSIONS
  HIV-infected patients with severe sepsis continue to suffer worse outcomes compared with HIV-uninfected patients in a large urban safety-net hospital caring for patients with limited access to medical care. Further studies need to be done to investigate the effect of socioeconomic status and mitigate healthcare disparities among critically ill HIV-infected patients.
authors: 1Pulmonary Medicine, Department of Veterans Affairs, Atlanta, GA. 2Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, GA. 3Department of Medicine, Legacy Meridian Park Medical Center, Tualatin, OR. 4Emory University, Atlanta, GA. 5Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Sushma K
authors: SK
authors: Cribbs
authors: Caroline
authors: C
authors: Tse
authors: Joel
authors: J
authors: Andrews
authors: Neeta
authors: N
authors: Shenvi
authors: Greg S
authors: GS
authors: Martin
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003428:Cross Infection / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000150:complications; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D012959:Socioeconomic Factors