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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2020

01-02-2020 | Tuberculosis | Narrative Review

Management of HIV-infected patients in the intensive care unit

Authors: François Barbier, Mervin Mer, Piotr Szychowiak, Robert F. Miller, Éric Mariotte, Lionel Galicier, Lila Bouadma, Pierre Tattevin, Élie Azoulay

Published in: Intensive Care Medicine | Issue 2/2020

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Abstract

The widespread use of combination antiretroviral therapies (cART) has converted the prognosis of HIV infection from a rapidly progressive and ultimately fatal disease to a chronic condition with limited impact on life expectancy. Yet, HIV-infected patients remain at high risk for critical illness due to the occurrence of severe opportunistic infections in those with advanced immunosuppression (i.e., inaugural admissions or limited access to cART), a pronounced susceptibility to bacterial sepsis and tuberculosis at every stage of HIV infection, and a rising prevalence of underlying comorbidities such as chronic obstructive pulmonary diseases, atherosclerosis or non-AIDS-defining neoplasms in cART-treated patients aging with controlled viral replication. Several patterns of intensive care have markedly evolved in this patient population over the late cART era, including a steady decline in AIDS-related admissions, an opposite trend in admissions for exacerbated comorbidities, the emergence of additional drivers of immunosuppression (e.g., anti-neoplastic chemotherapy or solid organ transplantation), the management of cART in the acute phase of critical illness, and a dramatic progress in short-term survival that mainly results from general advances in intensive care practices. Besides, there is a lack of data regarding other features of ICU and post-ICU care in these patients, especially on the impact of sociological factors on clinical presentation and prognosis, the optimal timing of cART introduction in AIDS-related admissions, determinants of end-of-life decisions, long-term survival, and functional outcomes. In this narrative review, we sought to depict the current evidence regarding the management of HIV-infected patients admitted to the intensive care unit.
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Metadata
Title
Management of HIV-infected patients in the intensive care unit
Authors
François Barbier
Mervin Mer
Piotr Szychowiak
Robert F. Miller
Éric Mariotte
Lionel Galicier
Lila Bouadma
Pierre Tattevin
Élie Azoulay
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 2/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-020-05945-3

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