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).
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.
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%).
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.