Should highly active antiretroviral therapy be prescribed in critically ill HIV-infected patients during the ICU stay A retrospective cohort studyReportar como inadecuado




Should highly active antiretroviral therapy be prescribed in critically ill HIV-infected patients during the ICU stay A retrospective cohort study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

AIDS Research and Therapy

, 9:27

First Online: 28 September 2012Received: 20 November 2011Accepted: 21 September 2012

Abstract

BackgroundThe impact of highly active antiretroviral therapy HAART in HIV-infected patients admitted to the intensive care unit ICU remains controversial. We evaluate impact of HAART prescription in HIV-infected patients admitted to the ICU of Tourcoing Hospital from January 2000 to December 2009.

ResultsThere were 91 admissions concerning 85 HIV-infected patients. Reasons for ICU admission were an AIDS-related diagnosis in 46 cases 51%. Fifty two patients 57% were on HAART at the time of ICU admission, leading to 21 immunovirologic successes 23%. During the ICU stay, HAART was continued in 29 patients 32%, and started in 3 patients 3%. Only one patient experienced an adverse event related to HAART. Mortality rate in ICU and 6 months after ICU admission were respectively 19% and 27%. Kaplan-Meier estimates of the cumulative unajusted survival probability over 6 months were higher in patients treated with HAART during the ICU stay Log rank: p = 0.04. No benefit of HAART in ICU was seen in the adjusted survival proportion at 6 months or during ICU stay. Prescription of HAART during ICU was associated with a trend to lower incidence of new AIDS-related events at 6 months respectively 17% and 34% with and without HAART, p = 0.07, and with higher incidence of antiretroviral resistance after ICU stay respectively 25% and 7% with and without HAART, p = 0.02.

ConclusionsOur results suggest a lower death rate over 6 months in critically ill HIV-infected patients taking HAART during ICU stay. The optimal time to prescribe HAART in critically ill patients needs to be better defined.

KeywordsHIV Intensive care HAART AbbreviationsAIDSAcquired immunodeficiency syndrome

CIConfidence interval

HAARTHighly active antiretroviral therapy

HIVHuman immunodeficiency virus

ICUIntensive care unit

IRISImmune reconstitution and inflammatory syndrome

NRTINucleoside-Nucleotide reverse transcriptase inhibitor

PIProtease inhibitor

OROdds ratio

SAPSSimplified acute physiology score.

Electronic supplementary materialThe online version of this article doi:10.1186-1742-6405-9-27 contains supplementary material, which is available to authorized users.

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Autor: Agnes Meybeck - Lydie Lecomte - Michel Valette - Nicolas Van Grunderbeeck - Nicolas Boussekey - Arnaud Chiche - Hugues Geor

Fuente: https://link.springer.com/







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