HIV, ART, and the ICU

• Though survival has dramatically improved for patients with HIV, there has been no decrease in the quantity of ICU admissions for this select patient population.
• One of the most common reasons for ICU admission is now adverse effects of antiretroviral therapy (ART).
• When managing a critically ill HIV patient in the ED or ICU, consider the following effects of ART as an etiology:
  • Lactic acidosis
    • Seen with nucleoside reverse transcriptase inhibitors (NRTIs): greatest risk with didanosine, stavudine, and zidovudine
    • Presentation: fatigue, malaise, vomiting, abdominal pain, hepatomegaly
    • Lactate often > 10 mmol/L
  • Abacavir hypersensitivity
    • Usually within first 6 weeks of drug initiation
    • Presentation: rash, fever, shortness of breath, vomiting, abdominal pain
    • Can rapidly progress to cardiovascular collapse

References

Tan DHS, Walmsley SL. Management of persons infected with human immunodeficiency virus requiring admission to the intensive care unit. Crit Care Clin 2013; 29:603-20.