Predictors of short-term mortality in HIV-infected patients admitted to Intensive Care Unit
Main Article Content
Abstract
Introduction: Historically, complications of HIV infection have been related to admissions to the Intensive Care Unit (ICU). Despite therapeutic advances, the results of the analysis of prognostic factors in patients with HIV/AIDS have varied, including late diagnosis and failure to adhere to antiretroviral treatment. Objective: To evaluate the predictors of short-term mortality in HIV-infected patients admitted to the ICU, as well as their sociodemographic and clinical characteristics. Methods: A retrospective cohort study including patients admitted to the ICU of a teaching hospital from 2003 through 2012. Data were collected from medical records after the Institutional Review Board approval. Results: 148 HIV-infected patients were identified and 131 were eligible. Among included patients, 42.75% were HIV new diagnoses and 5.34% had no information about the time of diagnosis. The main reasons for admission to the ICU were respiratory failure and sepsis while mortality was 70.23% between 2003 and 2012. Among the risk factors for mortality were low albumin, high APACHE, low CD4+ T lymphocyte count, and not using antiretroviral therapy. Conclusion: Despite the availability of diagnosis and treatment for HIV-infected individuals, the number of new cases of advanced Aids diagnosed in high-complexity services such as ICU is high, as well as the non-use of combination antiretroviral therapy. It is necessary to strengthen anti-HIV screening to detect and treat more cases in the early stages.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
Rosen MJ, Narasimhan M. Critical care of immunocompromised patients: human immunodeficiency virus. Crit Care Med. 2006;34(9 Suppl):S245-50. https://doi.org/10.1097/01.CCM.0000232491.15369.AB
Morris A, Masur H, Huang L. Current issues in critical care of the human immunodeficiency virus-infected patient. Crit Care Med. 2006;34(1):42-9. https://doi.org/10.1097/01.ccm.0000194539.50905.81
Vincent B, Timsit JF, Auburtin M, Schortgen F, Bouadma L,Wolff M, et al. Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era. Intensive Care Med. 2004;30(5):859-66. https://doi.org/10.1007/s00134-004-2158-z
Nickas G, Wachter RM. Outcomes of intensive care for patients with human immunodeficiency virus infection. Arch Intern Med. 2000;160(4):541-7. https://doi.org/10.1001/archinte.160.4.541
Hacker MA, Kaida A, Hogg RS, Bastos FI. The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006. Cad Saude Publica. 2007;23(Suppl. 3):S345-59. https://doi.org/10.1590/s0102-311x2007001500003
Powell K, Davis JL, Morris AM, Chi A, Bensley MR, Huang L. Survival for patients with HIV admitted to the ICU continues to improve in the current era of combination antiretroviral therapy. Chest. 2009;135(1):11-17. https://doi.org/10.1378/chest.08-0980
Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B. Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS. 2004;18(10):1429-33. https://doi.org/10.1097/01.aids.0000131301.55204.a7
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250-6. https://doi.org/10.1007/s00134-003-1662-x
Naidoo KS, Singh JA, Lalloo UG. HIV-AIDS and admission to intensive care units – a comparison of India, Brazil and South Africa. S Afr J HIV Med. 2013;14(1):15-16. https://doi.org/10.7196/sajhivmed.887
Chiang HH, Hung CC, Lee CM, Chen HY, Chen MY, Sheng WH, et al. Admissions to intensive care unit of HIV-infected patients in the era of highly active antiretroviral therapy: etiology and prognostic factors. Crit Care. 2011;15(4):R202. https://doi.org/10.1186/cc10419
Foo H, Clezy K, Post JJ. The long-term outcome of HIV- infected patients after intensive care admission. Int J STD AIDS 2012;23:e4-8. https://doi.org/10.1258/ijsa.2009.009341
Morquin D, Le Moing V, Mura T, Makinson A, Klouche K, Jonquet O, et al. Short- and long-term outcomes of HIV-infected patients admitted to the intensive care unit: impact of antiretrovi-ral therapy and immunovirological status. Ann Intensive Care. 2012;2(1):25. https://doi.org/10.1186/2110-5820-2-25
Barbier F, Roux A, Canet E, Martel-Samb P, Aegerter P, Wolff M, et al. Temporal trends in critical events complicating HIV infec-tion: 1999-2010 multicentre cohort study in France. Intensive Care Med. 2014;40(12):1906-15. https://doi.org/10.1007/s00134-014-3481-7
Turvey SL, Bagshaw SM, Eurich DT, Sligl WI. Epidemiology and outcomes in critically ill patients with human immunodeficiency virus infection in the era of combination antiretroviral therapy. Can J Infect Dis Med Microbiol. 2017;2017:7868954. https://doi.org/10.1155/2017/7868954
Croda J, Croda MG, Neves A, Santos SS. Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit. Crit Care Med. 2009;37(5):1605-11. https://doi.org/10.1097/CCM.0b013e31819da8c7
Amâncio FF, Lambertucci JR, Cota GF, Antunes CM. Predictors of the short- and long-term survival of HIV-infected patients admitted to a Brazilian intensive care unit. Int J STD AIDS. 2012;23(10):692-7. https://doi.org/10.1258/ijsa.2012.011389
Meybeck A, Lecomte L, Valette M, Van Grunderbeeck, N, Boussekey N, Chiche A, et al. Should highly active antiretro- viral therapy be prescribed in critically ill HIV-infected patients during the ICU stay? A retrospective cohort study. AIDS Res Ther. 2012;9(1):27. https://doi.org/10.1186/1742-6405-9-27
Pierantoni CR. 20 anos do sistema de saúde brasileiro: o Sistema Único de Saúde. Physis. 2008;18(4):617-24. http://dx.doi.org/10.1590/S0103-73312008000400002
Cao W, Jamieson BD, Hultin LE, Hultin PM, Effros RB, Detels R. Premature aging of T cells is associated with faster HIV-1 disease progression. J Acquir Immune Defic Syndr. 2009;50(2):137-47. http://dx.doi.org/10.1097/QAI.0b013e3181926c28
Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011;377(9781):1949-61. https://doi.org/10.1016/ S0140-6736(11)60135-9
Belloso WH, Orellana LC, Grinsztejn B, Madero JS, La Rosa A, Veloso VG, et al. Analysis of serious non-AIDS events among HIV-infected adults at Latin American sites. HIV Med. 2010;11(9):554-64. https://doi.org/10.1111/j.1468-1293.2010.00824.x
Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270-6. https://doi.org/10.1016/j.jcrc.2016.07.015
Soares M, Bozza FA, Angus DC, Japiassú AM, Viana WN, Costa R, et al. Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Med. 2015;41(12):2149-60. https://doi.org/10.1007/s00134-015-4076-7
Grangeiro A, Escuder MM, veras MA, Barreira D, Ferraz D, Kayano J. Voluntary counseling and testing (VCT) services and their contribution to access to HIV diagnosis in Brazil. Cad Saude Publica. 2009;25(9):2053-63. https://doi.org/10.1590/s0102-311x2009000900019
Brito AM, Kendall C, Kerr L, Mota RMS, Guimarães MDC, Dourado I, et al. Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil. PLoS One. 2015;10(6):e0130445. https://doi.org/10.1371/journal.pone.0130445
Cruz MM, Souza MS, Cota VL. Innovations in testing and linkage for hiv/aids treatment for vulnerable population in times of crisis. Temas Saude. 2020;20(4):91-109. https://doi.org/10.29327/213319.20.4-4
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais. Protocolo Clínico e Diretrizes Terapêuticas para Manejo da Infecção pelo HIV em Adultos. Brasília: Ministério da Saúde, 2018.
Xiao J, Zhang W, Huang Y, Tian Y, Su W, Li Y, et al. Etiology and outcomes for patients infected with HIV in intensive care units in a tertiary care hospital in China. J Med Virol. 2015;87(3):366-74. https://doi.org/10.1002/jmv.24063
Nuesch R, Geigy N, Schaedler E, Battegay M. Effect of highly active antiretroviral therapy on hospitalization characteris- tics of HIV-infected patients. Eur J Clin Microbiol Infect Dis. 2002;21(9):684-7. https://doi.org/10.1007/s10096-002-0792-3
Ganesan A, Masur H. critical care of persons infected with the human immunodeficiency virus. Clin Chest Med. 2013;34(2):307-23. https://doi.org/10.1016/j.ccm.2013.01.011
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793-800. https://doi.org/10.1093/cid/ciq243
Hall HI, Espinoza L, Benbow N, HU YW, Urban Areas HIV Surveillance Workgroup. Epidemiology of HIV infection in large urban areas in the United States. PLoS One. 2010;5(9):e12756. https://doi.org/10.1371/journal.pone.0012756
Iacob SA, Iacob DG, Jugulete G. Improving the adherence to antiretroviral therapy, a difficult but essential task for a successful hiv treatment-clinical points of view and practical considerations. Front Pharmacol. 2017;8:831. https://doi.org/10.3389/fphar.2017.00831
Oliveira RS, Primeira MR, Santos WM, Paula CC, Padoin SMM. Association between social support and adherence to anti-retroviral treatment in people living with HIV. Rev Gaúcha Enferm. 2020;41:e20190290. https://doi.org/10.1590/1983-1447.2020.20190290
O’Donnell EP, Scarsi KK, Darin KM, Gerzenshtein L, Postelnick MJ, Palella Jr FJ. Low incidence of renal impairment observed in tenofovir-treated patients. J Antimicrob Chemother. 2011;66(5):1120-6. https://doi.org/10.1093/jac/dkr039
Cihlar T, Ray AS. Nucleoside and nucleotide HIV reverse transcriptase inhibitors: 25 years after zidovudine. Antiviral Res. 2010;85(1):39-58. https://doi.org/10.1016/j.antiviral.2009.09.014
Wyatt CM. Kidney Disease and HIV Infection. Top Antivir Med. 2017;25(1):13-16.
Cribbs SK, Tse C, Andrews J, Shenvi N, Martin GS. Characteristics and Outcomes of HIV-Infected Patients With Severe Sepsis: Continued Risk in the Post-Highly Active Antiretroviral Therapy Era. Crit Care Med. 2015;43(8):1638-45. https://doi.org/10.1097/CCM.0000000000001003
Kwizera A, Nabukenya M, Peter A, Semogerere L, Ayebale E, Katabira C, et al. Clinical characteristics and short-term outcomes of HIV patients admitted to an African Intensive Care Unit. Crit Care Res Pract. 2016;2016:2610873. https://doi.org/10.1155/2016/2610873
Andrade HB, Shinotsuka CR, Ho L, Carvalho FB, Bozza FA, Japiassú AM. Systematic review of short-term prognostic factors of HIV patients admitted to an intensive care unit. J Bras Doenças Sex Transm 2017;29(2):36-43. https://doi.org/10.5533/DST-2177-8264-201729202