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Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients

¹ Dept of Infectious Diseases Service, ² Medical and ³ Respiratory Intensive Care Units, and ⁴ Microbiology Laboratory, Institut d'Investigacions Biomëdiques August Pi i Sunyer Hospital Clìnic, Facultat de Medicina, Universitat de Barcelona, Villarroel 170, Barcelona, Spain

CORRESPONDENCE: A. Torres, Respiratory Intensive Care Unit, Servei de pneumologia, Institut clínic de pneumologia, i Cirurgia Toràcia, Hospital Clìnic, Villarroel 170, 08036, Barcelona, Spain. Fax: 34 934515272

This work was supported by grants from SEIMC/API and Fundaciûn Maximo Soriano Gimènez.

The introduction of highly active antiretroviral therapy with protease inhibitors in 1996 has changed the morbidity and mortality of acquired immune deficiency syndrome patients. Therefore, the aetiologies and prognostic factors of human immunodeficiency virus (HIV)-infected patients with life-threatening respiratory failure requiring intensive care unit (ICU) admission need to be reassessed.

From 1993 to 1998, we prospectively evaluated 57 HIV patients (mean±sem age 36.5±1.3 yrs) admitted to the ICU showing pulmonary infiltrates and acute respiratory failure.

A total of 21 and 30 patients were diagnosed as having Pneumocystis carinii and bacterial pneumonia, respectively, of whom 13 and eight died during their ICU stay (p=0.01). Both groups of patients had similar age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and severity in respiratory failure. The number of cases with bacterial pneumonia admitted to ICU decreased after 1996 (p=0.05). Logistic regression analysis showed that (APACHE) II score >17, serum albumin level <25 g·L^–1, and diagnosis of P. carinii pneumonia were the only factors at entry associated with ICU mortality (p=0.02).

Patients with bacterial pneumonia are less frequently admitted to the intensive care unit after the introduction of highly active antiretroviral therapy with protease inhibitors in 1996. Compared to the previous series, it was observed that the few Pneumocystis carinii pneumonia patients that need intensive care still have a bad prognosis.

Keywords: bacterial pneumonia, HIV, Pneumocystis carinii, prognosis, respiratory failure

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