title: Epidemiology and Outcomes in Critically Ill Patients with Human Immunodeficiency Virus Infection in the Era of Combination Antiretroviral Therapy.
abstract: Purpose.The impact of critical illness on survival of HIV-infected patients in the era of antiretroviral therapy remains uncertain. We describe the epidemiology of critical illness in this population and identify predictors of mortality.Materials and Methods.Retrospective cohort of HIV-infected patients was admitted to intensive care from 2002 to 2014. Patient sociodemographics, comorbidities, case-mix, illness severity, and 30-day mortality were captured. Multivariable Cox regression analyses were performed to identify predictors of mortality.Results.Of 282 patients, mean age was 44 years (SD 10) and 169 (59%) were male. Median (IQR) CD4 count and plasma viral load (PVL) were 125 cells/mm3(30-300) and 28,000 copies/mL (110-270,000). Fifty-five (20%) patients died within 30 days. Factors independently associated with mortality included APACHE II score (adjusted hazard ratio [aHR] 1.12; 95% CI 1.08-1.16;p< 0.001), cirrhosis (aHR 2.30; 95% CI 1.12-4.73;p= 0.024), coronary artery disease (aHR 6.98; 95% CI 2.20-22.13;p= 0.001), and duration of HIV infection (aHR 1.07 per year; 95% CI 1.02-1.13;p= 0.01). CD4 count and PVL were not associated with mortality.Conclusions.Mortality from an episode of critical illness in HIV-infected patients remains high but appears to be driven by acute illness severity and HIV-unrelated comorbid disease rather than degree of immune suppression.
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Shannon L
authors.identifier: 0000-0003-4244-6468
authors.initials: SL
authors.lastname: Turvey
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Wendy I
authors.identifier: 0000-0003-4963-0401
authors.initials: WI
authors.lastname: Sligl