For Adult HIV Patients on Highly Active Antiretroviral Therapy, Will Continuation or Initiation of Therapy in Intensive Care Units Improve Patient Outcome During Hospitalization When Compared to Patients Not Receiving Therapy

摘要

Background: Patients with HIV are living longer due to the advent of highly active antiretroviral therapy (HAART). Before this therapy, admission to the intensive care unit (ICU) was perceived by some patients and providers to be an effort in futility. Now, outcomes appear to be improving for HIV infected patients living in the HAART era. There is no set standard among providers of whether or not to continue or begin this therapy in the intensive care unit. This medication has both benefits, such as bolstering patient’s immune system, and drawbacks, such as problems with adverse effect and drug to drug interactions. Currently, there is an unanswered question on whether or not continuing or starting this medication will improve mortality in the ICU for HIV patients.Clinical Question: Does the use of highly active antiretroviral medications reduce the mortality of patients in the ICU. Study Design: Exhaustive search of available medical literature.Methods: The focus of this study was to review current literature pertaining to highly active antiretroviral medication in HIV infected patients in the intensive care unit which looked at mortality rate of patients continuing, starting, or not using highly active antiretroviral therapy in the ICU.Results: An exhaustive literature search yielded two retrospective cohort studies specific for the clinical question. There were no randomized clinical trials on the topic. Both studies determined that patients on highly active antiretroviral therapy had decreased mortality rates in the intensive care unit. Patients with previous HAART use had the lowest mortality rate, followed by patients started on HAART. Finally patients receiving no HAART did the worst.Conclusion: This is an understudied evolving topic. More studies need to be implemented.