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14th Annual Conference of the British HIV Association23-25 April 2008, Belfast |
INTENSIVE CARE ADMISSION AND OUTCOME IN RELATION TO CD4 COUNT IN PATIENTS INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A SINGLE-CENTRE SURVEY
HIV Med 2008 Apr 23-25 (Suppl 1);14:7 (abstract no. O28)
L Turtle1, R Vyakernam2, G Davies1, M Nelson2 and N Soni2
1 Royal Liverpool University Hospital, Liverpool, UK, 2 Chelsea and Westminster Hospital, London, UK
BACKGROUND: Since the advent of highly active antiretroviral therapy (HAART) prognosis of advanced HIV infection is now much improved. Data from the pre-HAART era showed that survival from critical illness was related to CD4 count in HIV+ patients. We hypothesized that since the advent of HAART CD4 count would be unrelated to outcome following intensive care unit (ICU) admission.
METHODS: All HIV+ patients admitted to ICU at a single centre between April 2001 and April 2006 were included. Follow up was until April 2007. Demographics, clinical details, HIV viral load and CD4 count were collected retrospectively. Data were analyzed using Stata 10 software.
RESULTS: Forty three patients were admitted during the study period. Common reasons for admission were respiratory illness, 15 patients (34.9%); sepsis, 12 patients (27.9%); neurological illness, 4 patients (9.3%) and gastrointestinal illness, 4 patients (9.3%). Twenty seven patients (62.7%) were admitted for HIV related illness. Median length of stay on ICU was 6 days. Median CD4 counts were 100 (HIV related illness) and 177 (HIV unrelated illness). Mortality was 33.3% in ICU, 48.8% in hospital, 60.5% at one year and 67.4% overall. Univariate cox regression showed no correlation between CD4 count (hazard ratio (HR) 0.999, 95% CI 0.998-1.001, p=0.77) or HIV related illness (HR 1.62, 95% CI 0.74-3.54, p=0.22) and mortality, nor between multiple other variables, including age. Correlation of APACHE II with mortality approached statistical significance (HR 1.04, 95% CI 0.99-1.09, p=0.08).
CONCLUSIONS: The CD4 count no longer informs the decision of patient suitability for intensive care since the advent of HAART. These decisions should be based on patient wishes and conventional assessment tools.
2008-04-23
O28
Copyright © 2008 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD