Critical care of immunocompromised patients: Human immunodeficiency virus

Abstract

To describe critical illnesses that occur commonly in patients with human immunodeficiency virus (HIV) infection. We reviewed and summarized the literature on critical illness in HIV infection using a computerized MEDLINE search. In the last 10 yrs, our perception of HIV infection and acquired immune deficiency syndrome (AIDS) has changed from an almost uniformly fatal disease into a manageable chronic illness. Even patients with advanced immunosuppression may have prolonged survival, although usually with exacerbations and remissions, complicated by therapy-related toxicity and medical and psychiatric co-morbidity. The prevalence of opportunistic infections and the mortality have decreased considerably since early in the epidemic. The most common reason for intensive care unit admission in patients with AIDS is respiratory failure, but they are less likely to be admitted for Pneumocystis pneumonia and other HIV-associated opportunistic infections. HIV-infected persons are more likely to receive intensive care unit care for complications of end-stage liver disease and sepsis. Hepatitis C has emerged as a common cause of morbidity and mortality in patients with HIV infection. In addition, some develop life-threatening complications from antiretroviral drug toxicity and the immune reconstitution inflammatory syndrome.