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Critically Ill Patients with the HIV: 40 Years Later.

É. Azoulay,N. De Castro,F. Barbier

Published 2020 in Chest

ABSTRACT

The development of combination antiretroviral therapies (cART) in the mid-nineties has dramatically modified the clinical presentation of critically ill HIV-infected patients. Most of cART-treated patients ageing with controlled HIV replication are nowadays admitted to the intensive care unit (ICU) for non-AIDS-related events, mostly bacterial pneumonia and exacerbation of comorbidities, variably impacted by chronic HIV infection - e.g., chronic obstructive pulmonary disease, cardiovascular diseases, or solid neoplasms. Today, Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis, tuberculosis and other severe opportunistic infections only occur in patients with unknown viral status, limited access to cART, viral resistance, or compliance issues. Acute respiratory failure, neurological disorders and sepsis remain the main conditions that lead HIV-infected patients to the ICU though admissions for liver diseases or acute kidney injury are on the rise. Case fatality dropped substantially over the past decades reaching figures of HIV-uninfected critically ill patients with similar demographics, comorbidities, and level of organ dysfunctions. Several other facets of critical care management have evolved in this population, including diagnostic procedures, cART management at the acute phase of critical illness, and ethical considerations. In this narrative review, we sought to depict the current evidence and emerging challenges for the management of critically ill HIV-infected patients, almost 40 years after the onset of the AIDS epidemic.

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