Prognosis improves dramatically for HIV patients in the ICU

October 17, 2000

A study co-authored by Mayo Clinic and the University of Florida Health Science Center shows that the prognosis for HIV patients who are admitted to intensive care units is much better than it was in the mid-1980s. The study reports that the ICU mortality rate for HIV-infected patients has fallen to 29.6 percent. In the mid-1980s, ICU mortality was greater than 80 percent for this patient population. HIV (Human Immunodeficiency Virus) is the cause of the life-threatening health condition known as Acquired Immune Deficiency Syndrome (AIDS).

"HIV patients are surviving at greater rates because of a combination of health factors," says Bekele Afessa, M.D., Mayo Clinic pulmonary and critical care specialist and lead author of the study. "Physicians are using prophylactic drugs, antiretroviral therapies and new antibiotics to fight the life-threatening conditions that are associated with HIV. The growing knowledge of healthcare workers is another important factor in improved survival rates."

The study was designed to describe the clinical course and prognostic factors for HIV-infected patients. Researchers studied 141 patients who were admitted to the intensive care unit a total of 169 times between April 1995 and March 1999 at the University Medical Center in Jacksonville, Fla. Overall, 12 percent of HIV-related hospital admissions resulted in admission to the ICU. The most frequent reason for this was respiratory failure.

The most common immediate cause of death was bacterial infection. Of the patients studied, 78 percent developed organ failure, a significant indicator of outcomes. Patients who experienced the failure of only one organ were likely to survive, while patients who experienced multiple organ failure were less likely to live through hospitalization. Another risk factor for mortality was the development of SIRS (systemic inflammatory response syndrome).

Surprisingly, the helper T lymphocyte cell (CD4) count did not correlate with mortality. CD4 levels can decrease severely in advanced cases of HIV infection. Low levels indicate a lack of immune cells, which leaves the patient susceptible to other serious infections.

Researchers had predicted the mortality rate might be as high as 45 percent and were pleased when the actual rate was significantly lower. Dr. Afessa hopes that the results of the study will raise awareness about better survival rates in the HIV population. "Some patients and healthcare providers still believe that the prognosis for critically ill HIV patients is grim," he states. "It is our hope that people will approach the treatment of these patients more aggressively and positively and that prognoses will continue to improve."
The study was published in the July edition of Chest.

Autumn Latimore
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Mayo Clinic

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