title: A prospective study on the outcome of human immunodeficiency virus-infected patients requiring mechanical ventilation in a high-burden setting.
abstract: BACKGROUND
  There is a paucity of data on the mortality of patients admitted to the intensive care unit (ICU), despite the fact that human immunodeficiency virus (HIV)-related diseases represent a significant burden to health care resources particularly in sub-Saharan Africa.
  
  
  OBJECTIVE
  To describe the outcome and prognostic factors of HIV-infected patients requiring mechanical ventilation in an ICU.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  All 54 patients (34.8 ± 10.4 years, 38 females) admitted with confirmed HIV from October 2012 until May 2013 were enrolled. Disease severity was graded according to APACHEII score. Admission diagnoses, clinical features and laboratory investigations, complications and outcomes were recorded.
  
  
  RESULTS
  The mean length of ICU stay was 11.0 days (range: 1-49 days), and 33 patients survived (ICU mortality: 38.9%). The in-hospital mortality at 30 days was 48.1%. ICU mortality was associated with an AIDS-defining diagnosis (OR = 7.97, P = 0.003). Non-survivors had higher APACHEII scores (25.8 vs. 18.6, P = 0.001) and lower mean admission CD4 counts (102.5 vs. 225.2, P = 0.014). Multiple logistical regression analysis confirmed the independent predictive value of WHO stage 4 disease (P = 0.008), lower mean CD4 count on admission (P = 0.057) and higher APACHEII score (P = 0.010) on ICU mortality, and WHO stage 4 (P = 0.007) and higher APACHE II score (P = 0.003) on 30-day mortality.
  
  
  CONCLUSIONS
  The ICU mortality of mechanically ventilated HIV-positive patients was high. WHO stage 4 disease and a higher APACHEII score were predictive of both ICU and 30-day mortality, whereas a low CD4 count on admission was associated with ICU mortality.
authors.affiliation: From the Division of Pulmonology and cecilebalkema@gmail.com.
authors.forename: C A
authors.initials: CA
authors.lastname: Balkema
authors.affiliation: From the Division of Pulmonology and.
authors.forename: E M
authors.initials: EM
authors.lastname: Irusen
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Stellenbosch University & Tygerberg Academic Hospital, Western Cape Province, Cape Town, South Africa.
authors.forename: J J
authors.initials: JJ
authors.lastname: Taljaard
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Stellenbosch University & Tygerberg Academic Hospital, Western Cape Province, Cape Town, South Africa.
authors.forename: M D
authors.initials: MD
authors.lastname: Zeier
authors.affiliation: From the Division of Pulmonology and.
authors.forename: C F
authors.initials: CF
authors.lastname: Koegelenberg
mesh_terms: D018806:APACHE; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy*; D012720:Severity of Illness Index; D013019:South Africa; D014944:World Health Organization; D055815:Young Adult