XVIII International AIDS Conference

Abstract

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Outcomes of HIV+ patients in critical care in pre and post-HAART eras in Argentina

S. Martini Novas1, G. Elbert1, L. Spadaccini1, I. Bourlot1, G. Signes1, F. Benedetti1, M. Cabrini1, M.E. Socías1, A. Sisto1, G. Rey Kelly1, C. Dillon2, D. Ceraso2, H. Pérez1, P. Cahn1

1Hospital Juan A Fernández, Infectious Diseases Unit, Buenos Aires, Argentina, 2Hospital Juan A Fernández, Intensive Care Unit, Buenos Aires, Argentina

Background: Previous studies have shown improved outcomes of HIV+ patients admitted to Intensive Care Unit (ICU) since the introduction of HAART, although data available from Latin America is scarce.
Objective: To evaluate differences in outcomes of HIV+ patients in the ICU in the pre and post-HAART eras.
Methods: Retrospective analysis of HIV+ patients admitted to a polyvalent ICU in Buenos Aires between 1992-2009. Demographic characteristics, APACHE-II score, opportunistic infections (OIs) prevalence and mortality were analyzed in two periods: pre-HAART (1992-1997) and post-HAART (1998-2009). Data on CD4+ cell-count in ICU medical records was available only after 1998.
Results: Of 9442 patients admitted between 1992-2009, 422 (4.5%) were HIV+. Mean APACHE-II: 21.13 (vs. 16.67 in HIV-). Mortality rate: 49.1% (vs. 27.7% in HIV-). In the post-HAART era, only 33.5% of patients were on HAART. 14.1% were newly diagnosed with HIV. Median CD4+ cell-count: 67.5 cell/mm3 (IQR 21-144).


 Pre-HAARTPost-HAART
n120302
Males, %7568
Age, mean years (SD)30.93 (0.38)38.01 (2.43)
APACHE-II score, mean20.3121.02
Mortality rate, %5347.7
OIs as reason for ICU admission, %5545
[Comparison between Pre and Post-HAART Eras]


Conclusions: Despite universal access to antiretroviral therapy is available in Argentina since 1992, only one third of patients were on HAART and 14% of patients were newly diagnosed with HIV. These facts may partly explain the high prevalence of OIs and mortality rate (with no significant change between both periods) observed in this population. New strategies are urgently needed to expand access to HAART and achieve earlier diagnosis in order to impact on the outcome of critically ill HIV+ patients.


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