HIV in the critically ill

   “Adapted from Oxford Textbook of Critical Care-Oxford University Press 2016”               

• Human immunodeficiency virus (HIV) is increasingly a controllable disease in North America and life expectancy in patients adherent to combination antiretroviral therapy (cART) is similar to the general population.
• The majority of a admissions of HIV positive patients to the ICU are for reasons unrelated to their HIV, although presentations due to opportunistic infections and malignancies must be considered in those with previously undiagnosed infection or in those patients non-adherent to cART.
• The CD4 count is critical in determining the degree of immune suppression in a patient and should be checked in all critically ill HIV-infected patients to determine appropriate work-up and management of HIV- related infections/complications.
• It is important to involve an infectious disease specialist familiar with HIV in the care of a critically ill HIV-infected patient, particularly if therapy requires alterations or cessation of cART or if the patient is found to be significantly immunocompromised.
• Antiretroviral agents have many potential drug interactions and rare toxicities which must be evaluated throughout the ICU stay as concomitant medications are introduced.