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01.10.2009 | Original

Etiologies and outcome of acute respiratory failure in HIV-infected patients

verfasst von: François Barbier, Isaline Coquet, Stéphane Legriel, Juliette Pavie, Michael Darmon, Julien Mayaux, Jean-Michel Molina, Benoît Schlemmer, Élie Azoulay

Erschienen in: Intensive Care Medicine | Ausgabe 10/2009

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Abstract

Objective

To assess the etiologies and outcome of acute respiratory failure (ARF) in HIV-infected patients over the first decade of combination antiretroviral therapy (ART) use.

Methods

Retrospective study of all HIV-infected patients (n = 147) admitted to a single intensive care unit (ICU) for ARF between 1996 and 2006.

Results

ARF revealed the diagnosis of HIV infection in 43 (29.2%) patients. Causes of ARF were bacterial pneumonia (n = 74), Pneumocystis jirovecii pneumonia (PCP, n = 52), other opportunistic infections (n = 19), and noninfectious pulmonary disease (n = 33); the distribution of causes did not change over the 10-year study period. Two or more causes were identified in 33 patients. The 43 patients on ART more frequently had bacterial pneumonia and less frequently had opportunistic infections (P = 0.02). Noninvasive ventilation was needed in 49 patients and endotracheal intubation in 42. Hospital mortality was 19.7%. Factors independently associated with mortality were mechanical ventilation [odds ratio (OR) = 8.48, P < 0.0001], vasopressor use (OR, 4.48; P = 0.03), time from hospital admission to ICU admission (OR, 1.05 per day; P = 0.01), and number of causes (OR, 3.19; P = 0.02). HIV-related variables (CD4 count, viral load, and ART) were not associated with mortality.

Conclusion

Bacterial pneumonia and PCP remain the leading causes of ARF in HIV-infected patients in the ART era. Hospital survival has improved, and depends on the extent of organ dysfunction rather than on HIV-related characteristics.

This work was presented in part at the American Thoracic Society International Conference, 16–21 May 2008, Toronto, Canada (Abstract no. 2086) [18].

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Titel: Etiologies and outcome of acute respiratory failure in HIV-infected patients
verfasst von: François Barbier
Isaline Coquet
Stéphane Legriel
Juliette Pavie
Michael Darmon
Julien Mayaux
Jean-Michel Molina
Benoît Schlemmer
Élie Azoulay
Publikationsdatum: 01.10.2009
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 10/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1559-4

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Etiologies and outcome of acute respiratory failure in HIV-infected patients