survival trends in critically ill hiv-infected patients in the highly active antiretroviral therapy era生存的趋势危重感染艾滋病毒的病人在高效抗逆转录病毒疗法时代.pdfVIP

Coquet et al. Critical Care 2010, 14:R107 /content/14/3/R107 R E S E A R C H Open Access Research Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era 1 2 3 1 1 1 Isaline Coquet , Juliette Pavie , Pierre Palmer , François Barbier , Stéphane Legriel , Julien Mayaux , Jean 2 1 1 Michel Molina , Benoît Schlemmer and Elie Azoulay* Abstract Introduction: The widespread use of highly active antiretroviral therapy (ART) has reduced HIV-related life-threatening infectious complications. Our objective was to assess whether highly active ART was associated with improved survival in critically ill HIV-infected patients. Methods: A retrospective study from 1996 to 2005 was performed in a medical intensive care unit (ICU) in a university hospital specialized in the management of immunocompromised patients. A tota l of 284 critically ill HIV-infected patients were included. Differences were sought across four time periods. Risk factors for death were identified by multivariable logistic regression. Results: Among the 233 (82%) patients with known HIV infection before ICU admission, 64% were on highly active ART. Annual admissions increased over time, with no differences in reasons for admission: proportions of patients with newly diagnosed HIV, previous opportunistic infection, CD4 counts, viral load, or acute disease severity. ICU and 90-day mortality rates decreased steadily: 25% and 37.5% in 1996 to 1997, 17.1% and 17.1% in 1998 to 2000, 13.2% and 13.2% in 2001 to 2003, and 8.6% in 2004 to 2005. Five factors were independently associated with increased ICU mortality: delayed ICU a