Few modern diseases have experienced as rapid and dramatic change in prognosis and treatment as HIV infection. The introduction of active antiretroviral therapy (ART) and effective prophylaxis of opportunistic infections ushered in a new era in the treatment of HIV infection and changed dramatically the natural history of this disease. The rates of admission to the intensive care unit (ICU) and intensive care mortality in patients with HIV infection have shifted repeatedly during the AIDS epidemic, influenced by attitudes of patients and providers toward utility of care. In the ART era, patients with HIV infection admitted to the ICU fall into 3 general categories: those with AIDS-related opportunistic infections, those who are experiencing complications related to ART, and those with medical problems unrelated to HIV infection. In this article, the authors provide a review of the most common life-threatening complications in patients with HIV infection.
Torre D., Speranza F., Martegani R.Impact of highly active antiretroviral therapy on organ-specific manifestations of HIV-1 infection. HIVMed.2005;6:66-78.
2.
Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators . N Engl J Med.1998;338:853-860.
3.
Morris A., Creasman J., Turner J., et al. Intensive care of human immunodeficiency virus-infected patients during the era of highly active antiretroviral therapy. Am J Respir Crit Care Med.2002;166:262-267.
4.
Narasimham M. , Posner AJ, Depalo VE, et al. Intensive care in patients with HIV infection in the era of highly active antiretroviral therapy. Chest. 2004;125:1800-1804.
5.
Khouli H., Afrasaiabi A., Shibli M., et al. Outcome of critically ill human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. J Intensive Care Med.2005;20:279-285.
6.
Casalino E., Wolff M., Ravaud P., et al. Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS. 2004;18: 1429-1433.
7.
Morris A., Masur H., Huang L.Current issues in critical care of the human immunodeficiency virus-infected patient. Crit Care Med.2006; 34:42-49.
8.
Rosen MJIntensive care of patients with human immunodeficiency virus infection: time to take another look. J Intensive Care Med.2005;20:312.
9.
Franklin C., Weisntein RAOut of intense complexities, intense simplicities emerge: AIDS in the intensive care unit. Crit Care Med.2006;34:42-49.
10.
Vincent B., Timsit JF, Auburtin M., et al. Characteristic and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era. Intensive Care Med.2004; 30:859-866.
11.
Wachter RM, Luce JM, Turner J., et al. Intensive care of patients with the acquired immunodeficiency syndrome: outcome and changing patterns of utilization. Am Rev Respir Dis.1986;134:891-896.
12.
Wachter RM, Luce JM, Hopewell PCCritical care of patients with AIDS. JAMA.1992;267:541-547.
13.
Wolff AJ, O'Donnell AEPulmonary manifestations of HIV infection in the era of highly active antiretroviral therapy. Chest. 2001;120:1888-1893.
14.
Rimland D., Navin TR, Lennox JL, et al. Prospective study of etiologic agents of community-acquired pneumonia in patients with HIV infection. AIDS. 2002;16:85-95.
15.
Benson CA, Kaplan JE, Masur H., et al. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from the CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Disease Society of America . Clin Infect Dis.2005;40:S159-S160.
16.
Hughes WTPneumocystis carinii pneumonia. N Engl J Med.1977;297:1381-1383.
17.
Fauci AS, Macher AM, Longo DL, et al. Acquired immunodeficiency syndrome: epidemiologic, clinical, immunologic and therapeutic considerations. Ann Intern Med.1984;100:92-106.
18.
Stringer JR , Beard CB, Miller RF, Wakefield AEA new name (Pneumocystis jirovecii) for Pneumocystis from humans. Emerg Infect Dis. 2003;9:276-277.
19.
Rosen M., Cucco R., Teirstein A.Outcome of intensive care in patients with the acquired immunodeficiency syndrome . J Intensive Care Med.1986;1:55-60.
20.
Kaplan JE, Hanson D., Dworkin MS, et al. Epidemiology of human inmmunodeficiency virus—associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis.2000 ;30:S5-S14.
21.
Curtis JR, Yarnold PR, Schwartz DN, et al. Improvements in outcomes of acute respiratory failure for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia. Am J Respir Crit Care Med.2000;162:393-398.
22.
Thomas CF, Limper AHPneumocystis pneumonia. N Engl J Med.2004 ;350:2487-2498.
23.
Masur H. Prevention and treatment ofPneumocystis pneumonia. N Engl J Med.1992;327:1853-1860.
24.
Walzer PD, George Smulian A.Pneumocystis species. In: Mandell G, Bennet JE, Dolin R, ed. Principles and Practices of Infections Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone; 2005:3080-3094.
Jules-Elysee KM, Stover DE, Zaman MB, et al. Aerosolized pentamidine: effect on diagnosis and presentation of Pneumocystis carinii pneumonia. Ann Intern Med.1990; 112:750-757.
27.
Huang L., Hecht FM, Stansell JD, et al. Suspected Pneumocystis carinii pneumonia with a negative induced sputum examination. Am J Respir Crit Care Med.1995;151:1866-1871.
28.
Baughman RP , Dohn MN, Frame PTThe continuing utility of bronchoalveolar lavage to diagnose opportunistic infections in AIDS patients. Am J Med.1994;97:515-522.
29.
Lau WK, Young LSTrimethoprim-sulfamethoxazole treatment of Pneumocystis carinii pneumonia in adults. N Engl J Med.1976;295:716-718.
30.
Gordin FM, Simon GL, Wofsy CB, Mills J.Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med.1984;100:459-499.
31.
Sattler FR, Cowan R., Nielsen DM, Ruskin J.Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Ann Intern Med.1988;109: 280-287.
32.
Helweg-Larsen J., Benfield TL, Eugen-Olsen J., et al. Effects of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated P carinii pneumonia. Lancet. 1999;354:1347-1351.
33.
Kazanjian P. , Locke AB, Hossler PA, et al. Pneumocystis carinii mutations associated with sulfa and sulfone prophylaxis failures in AIDS patients. AIDS. 1998;12:873-878.
34.
Crothers K. , Beard CB, Turner J., et al. Severity and outcome of HIV-associated Pneumocystis pneumonia containing Pneumocystis jirovecii dyhidropteroate synthase gene mutations. AIDS. 2005;19:801-805.
35.
Gagnon S., Boota AM, Fischl MA, et al. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. N Engl J Med.1990;323:1444-1450.
36.
Bozzette SA , Sattler FR, Chiu J., et al. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. N Engl J Med.1990 ;323:1451-1457.
37.
Morris A., Wachter RM, Luce J., et al. Improved survival with highly active antiretroviral therapy in HIV-infected patients with Pneumocystis carinii pneumonia. AIDS. 2003;17:73-80.
38.
Rosenberg AL , Seneff MG, Atiyeh L., et al. The importance of bacterial sepsis in intensive care unit patients with acquired immunodeficiency syndrome: implications for future care in the age of increasing antiretroviral resistance. Crit Care Med.2001;29:548-556.
39.
DeSimone JA , Pomerantz RJ, Babinchak TJInflammatory reactions in HIV-1 infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med.2000; 133:447-454.
40.
Shelburne SA III, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome. Medicine. 2002;81:213-227.
41.
Shelburne SA , Visnegarwala F., Darcourt J., et al. Incidence and risk factors for immune reconstitution syndrome during highly active antiretroviral therapy. AIDS. 2005;19:399-406.
42.
Wislez M., Bergor E., Antoine M., et al. Acute respiratory failure following HAART introduction in patients treated for Pneumocystis carinii pneumonia. Am J Respir Crit Care Med.2001;164:847-851.
43.
Lawn SD, Gail Bekker L, Miller RFImmune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis. 2005;5:361-373.
44.
Narita M., Ashkin D., Hollender ES, Pitchenik AEParadoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med.1998;158:157-161.
45.
Burman WJ, Jones BETreatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. Am J Resp Crit Care Med.2001;164:7-12.
46.
Cossarizza A. , Moyle G.Antiretroviral nucleoside and nucleotide analogues and mitochondria. AIDS. 2004;18:137-151.
47.
Gerard Y., Maulin L., Yazdanpanah Y., et al. Symptomatic hyperlactataemia: en emerging complication of antiretroviral therapy. AIDS. 2000;14:2723-2730.
48.
Moyle GJ, Datta D., Mandalia S., et al. Hyperlactataemia and lactic acidosis during antiretroviral therapy: relevance, reproducibility and possible risk factors. AIDS . 2002;16: 1341-1349.
49.
Chapplain JM , Beillot J., Begue J., et al. Mitochondrial abnormalities in HIV-infected lipoatrophic patients treated with antiretroviral agents. J Acquir Immune Defic Syndr. 2004; 37:1477-1488.
50.
Guidelines for the use of antiretrovirals agents in HIV-1-infected adults and adolescents. Available at: http://aidsinfo.nih.gov. Accessed May 6, 2006.
51.
Claessens YE , Chiche JD, Mira JP, et al. Bench-to-bedside review: severe lactic acidosis in HIV patients treated with nucleoside analogues reverse transcriptase inhibitors. Crit Care. 2003;7:226-232.
52.
Simpson DM, Tagliati M.Neurologic manifestation of HIV infection. Ann Intern Med.1994;121:769-785.
53.
Antinori A. , Larusa D., Cingolani A., et al. Prevalence, associated factors and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy. Clin Infect Dis.2004; 39:1681-1691.
54.
Montoya JG, Kovacs JA, Remington JSToxoplasma gondii. In: Mandell G, Bennet JE, Dolin R, eds. Principles and Practices of Infections Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone; 2005.
55.
Dannemann B. , McCutchan A., Israelski D., et al. Treatment of toxoplasmic encephalitis in patients with AIDS. Ann Intern Med.1999 ;116:33-43.
56.
Luft BJ, Hafner R., Korzun AH, et al. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. N Engl J Med.1993;329:995-1000.
Torre D., Casari S, Speranza, et al. Randomized trial of trimethoprim-sulfamethoxazole versus pyrimethaminesulfadiazine for therapy of toxoplasmic encephalitis in patients with AIDS. Italian Collaborative Study Group. Antimicrob Agents Chemother.1998;42:1346-1349.
59.
Collazos J.Opportunistic infections of the CNS in patients with AIDS. CNSDrugs. 2003;17:869-887.
60.
Powderly WGCryptococcal meningitis in AIDS. Clin Infect Dis.1993;17:837-842.
61.
Darras-Joly C., Chevret S., Wolff M., et al. Cryptococcus neoformans infection in France: epidemiologic features of and early prognostic parameters for 76 patients who were infected with the human immunodeficiency virus. Clin Infect Dis.1996;23:369-376.
62.
Saag MS, Graybill RJ, Larsen RA, et al. Practice guidelines for the management of cryptococcal disease . Clin Infect Dis.2000;30:710-718.
63.
Van Der Horst CM, Saag MS, Cloud GA, et al. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med.1997;337: 15-21.
64.
Graybill JR , Sobel J., Saag M., et al. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. Clin Infect Dis.2000;30: 47-54.
65.
Sun HY, Hung CC, Chang Sch.Management of cryptococcal meningitis with extremely high intracranial pressure in HIV-infected patients. Clin Infect Dis.2004;38:1790-1792.
66.
Newton PN, Thai LH, Tip NQ, et al. A randomized, double-blind, placebo-controlled trial of acetazolamide for the treatment of elevated intracranial pressure in cryptococcal meningitis . Clin Infect Dis.2002;35:769-772.
67.
Skiest DJFocal neurologic disease in patients with acquired immunodeficiency syndrome . Clin Infect Dis.2002; 34:103-115.
68.
Kasamon YL, Ambinder RFAIDS related primary central nervous lymphoma. Hematol Oncol Clin North Am.2005; 19:665-687.
69.
Bossolasco S., Cinque P., Ponzoni M., et al. Epstein-Barr virus DNA in cerebrospinal fluid and plasma of patients with AIDS-related lymphoma. J Neurovirol. 2002;8:432-438.
70.
Arribas JR, Clifford DB, Fitchtenbaum CJ, et al. Detection of Epstein-Barr virus DNA in cerebrospinal fluid for diagnosis of AIDS-related central nervous system lymphoma. J Clin Microbiol.1995;33:1580-1583.
71.
Soni N., Pozniak A.Continuing HIV therapy in the ICU. Crit Care. 2001;5:247-248.
72.
Clavel F., Hance AJHIV drug resistance. N Engl J Med.2004;350:1023-1035.
73.
Halpern SDHIV testing without consent in critically ill patients. JAMA.2005;294:734-736.
74.
Bayer R.public health policy and the AIDS epidemic: an end to HIV exceptionalism?N Engl J Med.1991;324:1500-1504.
75.
American Medical Association.H-20.920 HIV testing. Available at: http://www.ama-assn.org .
