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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 2017, Article ID 7868954, 9 pages
https://doi.org/10.1155/2017/7868954
Research Article

Epidemiology and Outcomes in Critically Ill Patients with Human Immunodeficiency Virus Infection in the Era of Combination Antiretroviral Therapy

1Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
2Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
3School of Public Health, University of Alberta, Edmonton, AB, Canada

Correspondence should be addressed to Wendy I. Sligl; ac.atreblau@lgilsw

Received 3 December 2016; Revised 30 January 2017; Accepted 8 February 2017; Published 27 February 2017

Academic Editor: Aim Hoepelman

Copyright © 2017 Shannon L. Turvey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. The impact of critical illness on survival of HIV-infected patients in the era of antiretroviral therapy remains uncertain. We describe the epidemiology of critical illness in this population and identify predictors of mortality. Materials and Methods. Retrospective cohort of HIV-infected patients was admitted to intensive care from 2002 to 2014. Patient sociodemographics, comorbidities, case-mix, illness severity, and 30-day mortality were captured. Multivariable Cox regression analyses were performed to identify predictors of mortality. Results. Of 282 patients, mean age was 44 years (SD 10) and 169 (59%) were male. Median (IQR) CD4 count and plasma viral load (PVL) were 125 cells/mm3 (30–300) and 28,000 copies/mL (110–270,000). Fifty-five (20%) patients died within 30 days. Factors independently associated with mortality included APACHE II score (adjusted hazard ratio [aHR] 1.12; 95% CI 1.08–1.16; ), cirrhosis (aHR 2.30; 95% CI 1.12–4.73; ), coronary artery disease (aHR 6.98; 95% CI 2.20–22.13; ), and duration of HIV infection (aHR 1.07 per year; 95% CI 1.02–1.13; ). CD4 count and PVL were not associated with mortality. Conclusions. Mortality from an episode of critical illness in HIV-infected patients remains high but appears to be driven by acute illness severity and HIV-unrelated comorbid disease rather than degree of immune suppression.