Respiratory virus-associated infections in HIV-infected adults admitted to the intensive care unit for acute respiratory failure: a 6-year bicenter retrospective study (HIV-VIR study)

Alexandre Elabbadi,Benoit Visseaux,Aurélie Schnuriger,Vincent Labbé,Juliette Patrier,Lila Bouadma,Quentin Philippot,Guillaume Voiriot,Muriel Fartoukh,Jérémie Pichon,Stéphane Ruckly,Jean-François Timsit

doi:10.1186/s13613-020-00738-9

Abstract

IntroductionAcute respiratory failure is the main reason for admission to the intensive care unit (ICU) in HIV-infected adults. There is little data about the epidemiology of respiratory viruses in this population.MethodsHIV-infected adults admitted to two intensive care units over a 6-year period for an acute respiratory failure and explored for respiratory viruses with multiplex polymerase chain reaction (mPCR) were retrospectively selected. Objectives were to describe the prevalence of respiratory viruses, coinfections with non-viral pathogens, and hospital outcome.ResultsA total of 123 episodes were included. An HIV infection was newly diagnosed in 9% of cases and 72% of the population were on antiretroviral therapy. Real-time mPCR tests identified at least one respiratory virus in the respiratory tract of 33 (27%) patients, but with a non-viral copathogen in two-thirds of cases. Rhinovirus was predominant, documented in 15 patients, followed by Influenza and Respiratory Syncytial Viruses (both n = 6). The prevalence of respiratory virus-associated infection did not vary along with the level of the CD4 T-cell deficiency, except for Rhinovirus which was more prevalent in patients with a CD4 lymphocyte count below 200 cells/µL (n = 13 (20%) vs. n = 2 (4%), p < 0.01). In multivariate analysis, respiratory virus-associated infection was not associated with a worse prognosis.ConclusionsViruses are frequently identified in the respiratory tract of HIV-infected patients with acute respiratory failure that requires ICU admission, but with a non-viral copathogen in two-thirds of cases. Rhinovirus is the predominant viral specie; its prevalence is highest in patients with a CD4 lymphocyte count below 200 cells/µL.

Highlights

Acute respiratory failure is the main reason for admission to the intensive care unit (ICU) in HIVinfected adults
Using nucleic acid amplification test such as multiplex polymerase chain reaction, these pathogens have been shown highly prevalent (20–56%) in large cohorts of adult patients admitted to the ICU for all-cause Acute respiratory failure (ARF) [7, 8], community-acquired pneumonia [9, 10], hospitalacquired pneumonia [11], acute exacerbation of chronic obstructive pulmonary disease (COPD) [12, 13], and asthma [14], compared to asymptomatic adults [15, 16]
Little is known about the epidemiology of respiratory viruses in Human immunodeficiency virus (HIV)-infected patients [19, 20], especially those admitted to the ICU, and the prevalence of respiratory viruses according to the CD4 T-cell deficiency

Summary

Introduction

Acute respiratory failure is the main reason for admission to the intensive care unit (ICU) in HIVinfected adults. Acute respiratory failure (ARF) is the leading cause of admission to the intensive care unit (ICU) in HIVinfected patients [1,2,3]. The Elabbadi et al Ann. Intensive Care (2020) 10:123 burden of non-HIV-related pulmonary events, such as bacterial pneumonia, acute bronchitis and acute exacerbation of chronic obstructive pulmonary disease (COPD) has been shown increasing [2, 3, 6]. Intensive Care (2020) 10:123 burden of non-HIV-related pulmonary events, such as bacterial pneumonia, acute bronchitis and acute exacerbation of chronic obstructive pulmonary disease (COPD) has been shown increasing [2, 3, 6] These important changes in the etiologic panel of ARF in HIV-infected patients question the role of respiratory viruses.

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