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Open Access Highly Accessed Research article

Late HIV diagnosis is a major risk factor for intensive care unit admission in HIV-positive patients: a single centre observational cohort study

Julia Shrosbree1, Lucy J Campbell2, Fowzia Ibrahim2, Phillip Hopkins1, Marcela Vizcaychipi3, Stephanie Strachan1 and Frank A Post12*

Author Affiliations

1 King's College Hospital, Bessemer Road, London SE5 9RS, UK

2 King's College London School of Medicine, Weston Education Centre (2.53), Cutcombe Road, London SE5 9RJ, UK

3 Chelsea and Westminster Hospital, Fulham Road, London, SW10 9NH, UK

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BMC Infectious Diseases 2013, 13:23  doi:10.1186/1471-2334-13-23

Published: 19 January 2013

Abstract

Background

HIV positive patients are at risk of infectious and non-infectious complications that may necessitate intensive care unit (ICU) admission. While the characteristics of patients requiring ICU admission have been described previously, these studies did not include information on the denominator population from which these cases arose.

Methods

We conducted an observational cohort study of ICU admissions among 2751 HIV positive patients attending King’s College Hospital, South London, UK. Poisson regression models were used to identify factors associated with ICU admission.

Results

The overall incidence rate of ICU admission was 1.0 [95% CI 0.8, 1.2] per 100 person-years of follow up, and particularly high early (during the first 3 months) following HIV diagnosis (12.4 [8.7, 17.3] per 100 person-years compared to 0.37 [0.27, 0.50] per 100 person-years thereafter; incidence rate ratio 33.5 [23.4, 48.1], p < 0.001). In time-updated analyses, AIDS and current CD4 cell counts of less than 200 cells/mm3 were associated with an increased incidence of ICU admission while receipt of combination antiretroviral therapy (cART) was associated with a reduced incidence of ICU admission. Late HIV diagnosis (initial CD4 cell count <350 or AIDS within 3 months of HIV diagnosis) applied to 81% of patients who were first diagnosed HIV positive during the study period and who required ICU admission. Late HIV diagnosis was significantly associated with ICU admission in the first 3 months following HIV diagnosis (adjusted incidence rate ratio 8.72, 95% CI 2.76, 27.5).

Conclusions

Late HIV diagnosis was a major risk factor for early ICU admission in our cohort. Earlier HIV diagnosis allowing cART initiation at CD4 cell counts of 350 cells/mm3 is likely to have a significant impact on the need for ICU care.

Keywords:
ICU; Intensive care; HIV; Antiretroviral therapy; cART; Immunodeficiency; Late