Mortality rates decrease, chronic disease rates increase among HIV+ ICU patients

May 23, 2012

The expanded use of antiretrovirals, potent drugs used to treat retroviral infections such as human immunodeficiency virus (HIV), has been linked to significant decreases in hospital mortality rates among severely ill HIV-positive(HIV+) patients nationwide, primarily due to a decrease in opportunistic infections, according to a new study by researchers at Stanford University. Despite these encouraging data, the study also revealed that in this population, chronic diseases and bloodstream infections are on the rise.

The study results will be presented at the ATS 2012 International Conference in San Francisco.

"The national expansion of antiretroviral programs has appeared to yield benefits well beyond the outpatient setting," said study lead author Monica Bhargava, MD, MS, adjunct in Stanford University's Division of Pulmonary and . "In the 1980s, HIV+ were often declined ICU admission because their prognosis was deemed far too grave. Our work shows that this has changed substantially since the advent of the antiretroviral era. The broader use of such medications is having a wide-ranging impact."

Although previous studies have shown that the initiation in the mid-1990s of antiretroviral therapy (ART) for the treatment of HIV has led to sharp reductions in mortality across the United States, Dr. Bhargavasaid that until now, the effect on critically ill HIV+ patients had not been assessed with a nationally-representative sample.

"We wanted to examine the impact of the ART era on in-hospital mortality among critically ill HIV+ patients, particularly those requiring mechanical ventilation, using a nationwide sample," she said. "We also wanted to evaluate hospital length of stay (LOS), and the prevalence of selected diseases among these patients."

For their study, the researchers used data spanning the 16-year period from 1993 to 2008, culled from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), a database of hospital inpatient stays used by researchers and policymakers to identify, track and analyze national trends in health care. For each year, statistical analyses were performed to isolate the effect of HIV+ status on mortality, controlling for socioeconomic, demographic and hospital characteristics.

"We found that, although nationally, the number of HIV+ requiring mechanical ventilation rose from 7,632 in 1993 to 10,775 in 2008, mortality in that population declined from over 63 percent in 1993 to 41.4 percent in 2008, with the sharpest decline occurring in 1996-1997, the beginning of the ART era," Dr. Bhargava said.

This decrease is most likely due to the concomitant decline in the occurrence of opportunistic infections, which are less likely in those on antiretroviral drugs, Dr. Bhargava said.In this study, Dr. Bhargavalooked at one such infection commonly associated with patients on mechanical ventilation, Pneumocystis carinii pneumonia (PCP), and found that among HIV+ patients who received , the rates of PCP infection nearly halved, from 29.2 percent in 1993 to 15.2 percent in 2008.

"It appears that the wider use of antiretroviral therapy has both decreased the percentage of patients with PCP and reduced mortalityin those patients who develop it," Dr. Bhargava said. "That is quite encouraging."

The researchers also found that median length of hospital stay declined in the HIV+ population during the study period, and this population also experienced a slower rate of growth in hospital charges relative to the general population. Black race remained the strongest independent predictor of in-hospital death.

"Our study confirms that major gains in in-hospital survival have occurred among HIV+ patients with respiratory failure, though there is still much more progress that needs to be made," Dr. Bhargava said. "In addition, there has been a notable increase in the diagnoses of sepsis, chronic obstructive airway disease, liver disease and coronary artery disease.

"Our work shows that our national efforts should focus more on managing and sepsis in this population," she added. "Future studies should help clarify the reasons behind the surge in sepsis and why ICU survival remains poorer among HIV+ ethnic minorities."

Explore further: HIV rate in SF could be cut sharply with expanded treatment, study predicts

More information: "HIV In The ICU: National Outcomes Of Patients In The ART Era" (Session D102, Wednesday, May 23, Room 131, Moscone Center; Abstract 31769)

Related Stories

HIV rate in SF could be cut sharply with expanded treatment, study predicts

April 13, 2011
If HIV-infected adults in San Francisco began taking antiretroviral treatments as soon as they were diagnosed, the rate of new HIV infections among men who have sex with men would be cut by almost 6o percent over five years, ...

Recommended for you

Scientists find where HIV 'hides' to evade detection by the immune system

October 19, 2017
In a decades-long game of hide and seek, scientists from Sydney's Westmead Institute for Medical Research have confirmed for the very first time the specific immune memory T-cells where infectious HIV 'hides' in the human ...

National roll-out of PrEP HIV prevention drug would be cost-effective

October 18, 2017
Providing pre-exposure prophylaxis (PrEP) medication to men who have sex with men who are at high risk of HIV infection (equivalent to less than 5% of men who have sex with men at any point in time) in England would be cost-effective, ...

Regulatory T cells harbor HIV/SIV virus during antiviral drug treatment

October 17, 2017
Scientists at Yerkes National Primate Research Center, Emory University have identified an additional part of the HIV reservoir, immune cells that survive and harbor the virus despite long-term treatment with antiviral drugs.

New research opens the door to 'functional cure' for HIV

October 17, 2017
In findings that open the door to a completely different approach to curing HIV infections, scientists from the Florida campus of The Scripps Research Institute (TSRI) have for the first time shown that a novel compound effectively ...

Researchers create molecule that could 'kick and kill' HIV

October 5, 2017
Current anti-AIDS drugs are highly effective at making HIV undetectable and allowing people with the virus to live longer, healthier lives. The treatments, a class of medications called antiretroviral therapy, also greatly ...

A sixth of new HIV patients in Europe 50 or older: study

September 27, 2017
People aged 50 and older comprise a growing percentage of HIV patients in Europe, accounting for one in six new cases in 2015, researchers said Wednesday.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.