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Infectious Diseases Physicians Approach to Antiretroviral Therapy in HIV/AIDS Patients Admitted to an Intensive Care Unit: An Emerging Infections Network Survey

George, Jomy M. PharmD*; Czosnowski, Quinn A. PharmD, BCPS*; Fraimow, Henry MD; Beekmann, Susan E. MPH, RN; Polgreen, Philip M. MD

Infectious Diseases in Clinical Practice: March 2014 - Volume 22 - Issue 2 - p 78–84
doi: 10.1097/IPC.0b013e318291c9de
Original Articles

Purpose: Little is known regarding administration of antiretroviral therapy (ART) regimens in the setting of critical illness. We developed a survey to better understand how infectious disease experts use ART in critically ill HIV/AIDS patients admitted to an intensive care unit (ICU).

Methods: Web-based surveys were distributed in October 2010 to the 1080 adult infectious disease physician members of the Emerging Infections Network. Responses were stratified by region, practice type, years of HIV experience, and by a cumulative HIV medicine score developed to measure expertise in managing HIV.

Results: A total of 501 members (46%) responded. In both ART-naive and -experienced patients, respondents were more likely to initiate or continue ART during treatment of an opportunistic infection (OI) (69% and 87%, respectively) than for low CD4 count/high viral load (25% and 79%, respectively). The OI for which respondents would most likely start ART was Pneumocystis jiroveci pneumonia. Reported barriers for use of ART in the ICU included immune reconstitution syndrome (71%), drug interactions (72%), and variable drug absorption (65%).

Conclusions: There is a lack of consensus of how to manage ART in the critically ill HIV patient. Infectious disease specialists were most likely to initiate or continue ART in the setting of an OI. Among OIs, respondents would most likely initiate ART for P. jiroveci pneumonia. Immune reconstitution syndrome, drug interactions, and outpatient follow-up were the most common reported barriers to use of ART in the ICU. Further studies are needed to provide better guidance on ART use in critically ill patients.

From the *Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA; †Division of Infectious Diseases, Department of Medicine, Cooper University Hospital, Camden, NJ; and ‡Emerging Infections Network, University of Iowa Carver College of Medicine, Iowa City, IA.

Correspondence to: Jomy George, PharmD, BCPS, Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 South 43rd St, GH-108K, Philadelphia, PA 19104. E-mail: j.george@usciences.edu.

The results of this study were presented as a poster at the Infectious Diseases Society of America Annual Meeting October 20–23, 2011.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This work was supported by grant/cooperative agreement no. U50 CCU112346 from the Centers for Disease Control and Prevention.

The authors have no conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.