Comparing Outcomes of HIV vs. Non-HIV Patients Requiring Mechanical Ventilation

Background Mechanical ventilation (MV) is a predictor of mortality in patients infected with human immunodeficiency virus (HIV) in the intensive care unit (ICU). Patients with HIV-infections are admitted to the ICU for a variety of reasons that frequently require intubation. While survival rates for HIV-infected patients continue to improve, ICU admission rates have remained consistent.

Methods To observe the consequences of MV in HIV-infected patients, we conducted a retrospective chart review on patients with HIV (n=55) vs. matched HIV-negative patients (n=55) who required MV over a one-year period and compared the groups for differences in outcome and complications.

Results The HIV group had twice the number of deaths (44% vs. 22%, P=0.01, all cause mortality). Among the HIV-positive group, 5/55 patients required tracheostomy and prolonged MV, compared to 15/55 in the control group (9% and 27%). Successful extubation was virtually identical (47% vs. 50%). Ventilator-associated pneumonia (VAP) was significantly higher among HIV-positive cases (39/55 HIV vs. 14/55 non-HIV, P=0.05). Regression analysis revealed that hypotension, hypoalbuminemia, and fever predicted a poorer outcome. Low CD4 cell counts were strongly associated with mortality.

Conclusion HIV-infected patients requiring MV have significantly higher mortality and VAP rates than HIV-negative patients. Since VAP is associated with a poor prognosis, discovering ways to reduce it in the HIV-infected patient may improve outcome.