464. Antiretroviral Therapy (ART) in HIV/AIDS Patients Admitted to an ICU: an Emerging Infections Network Query
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011_v2.pdf (244.2 kB)
  • Background: 

    There is increasing emphasis in treatment guidelines on the use of antiretroviral therapy (ART) at all stages of HIV infection. However, little is known regarding appropriate administration of ART regimens in the setting of critical illness.  We developed a survey to better understand how infectious diseases (ID) experts approach use of ART in critically ill HIV/AIDS patients admitted to an ICU.

    Methods:

    Web-based surveys were distributed in October 2010 to the 1080 adult ID physician members of the Emerging Infections Network.  Responses were stratified by region, practice type, years of HIV experience and by a cumulative HIV medicine score developed to measure expertise in managing HIV. Results were analyzed using the Pearson Chi-square test with Bonferroni correction (alpha level < 0.001).

    Results: 

    A total of 503 members (46%) responded.  Most respondents (58%) saw 5 or fewer HIV patients per month in their ICUs.  In both ART-naïve and -experienced patients, respondents were more likely to initiate or continue ART during treatment of an opportunistic infection (OI), (36% and 63.1%, respectively) than for low CD4 count/high viral load (21.4% and 58.7%, respectively).  City/county hospital providers were the most likely to initiate or continue ART in critically ill HIV patients.  Practitioners with a high HIV medicine score (considerable HIV experience >50 patients per month) were more likely to initiate or continue ART compared to those with some to no HIV experience (p < 0.0001).  The OIs for which respondents would most likely start or continue ART included Pneumocystis jiroveci pneumonia (PJP), cytomegalovirus, and cryptococcal meningitis Commonly reported barriers for use of ART in the ICU included immune reconstitution syndrome (IRIS; 48.3%), drug interactions (48.1%), and post-hospital follow up (44.3%).

    Conclusion: 

    ID specialists were most likely to initiate or continue ART in the ICU setting when the patient is being treated for an OI.  Among OIs, respondents would most likely initiate ART for PJP.  IRIS, drug interactions, and outpatient follow-up were the most common reported barriers to use of ART in the ICU. Further studies are needed to provide better guidance on ART use in critically ill patients.


    Subject Category: H. HIV/AIDS and other retroviruses

    Jomy George, PharmD, BCPS1,2, Quinn Czosnowski, PharmD, BCPS1,2, Henry Fraimow, MD1, Susan E. Beekmann, RN, MPH3 and Phillip M. Polgreen, MD3, (1)Cooper University Hospital, Camden, NJ, (2)Philadelphia College of Pharmacy, Philadelphia, PA, (3)Emerging Infections Network, Iowa City, IA

    Disclosures:

    J. George, None

    Q. Czosnowski, None

    H. Fraimow, None

    S. E. Beekmann, None

    P. M. Polgreen, None

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