HIV positive patients in intensive care - a retrospective chart review

• Main Author: Mkoko, Philasande
• Other Authors: Raine, Richard
• Format: Dissertation
• Language: English
• Published: University of Cape Town 2016
• Subjects: Medicine
• Online Access: http://hdl.handle.net/11427/20959

Background: The indications for and outcomes of intensive care unit (ICU) admission of HIV - infected patients in resource - poor settings like Sub - Saharan Africa are unknown. Methods: We reviewed case records of HIV - infected patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, South Africa from 1 January 2012 to 31 December 2012. HIV infection was defined as two positive antibody tests. Results: Seventy seven HIV - infected patients were admitted to ICU, 2 were younger than 18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during this period. HIV - positive patients had a mean (± standard deviation) CD 4 count of 293.9 × 10 6 /L ± 247.2 × 10 6 /L. Respiratory illness accounted for 30.7% of ICU admissions, community - acquired pneumonia was responsible for the majority of the respiratory cases. ICU and hospital mortality was 25.3% and 34.7% respectively. Predictors of ICU mortality included an APACHE Ι Ι score >13 (Odds Ratio {OR } , 1.4; 95% confidence interval {CI } 1.1 - 1.7; p value 0.015), receipt of renal replacement therapy (OR, 2.2; 95% CI 1.2 - 4.1; P 0.018) and receipt of inotropes (OR 2.3; 95% CI 1.6 - 3.4; P <0.001). Predictors of hospital mortality were severe sepsis on admission (OR, 2.8; 95% CI 0.9 - 9.1;p 0.07), receipt of renal replacement therapy (OR, 1.9; 95% CI 1.0 - 3.6; p 0.056), receipt of inotropic support (OR, 2.0; 95% CI 1.4 - 3.2; p 0.001). Use of highly active antiretroviral therapy, CD4 count, detectable HIV viral load and the diagnoses at ICU admission did not predict ICU or hospital mortality. Conclusion Respiratory illnesses remain the main indication for ICU in HIV infected patients. HIV is diagnosed late with patients presenting in dire straits. Receipt of HAART, CD4 count and the diagnoses at ICU admission are not predictors of ICU or hospital mortality, but rather the severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and renal replacement.