SEARCHCOHORTinfectious_disease, critical_care

cohort·infectious_disease, critical_care, internal_medicine, oncology·PMC10012467

Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort

Critical Care · 15 authors, 15 centres

AI SUMMARY

FIDELITY 94%

POPULATIONHIV-infected adult patients (≥18 years) admitted to ICU in French university and non-university hospitals participating in the OutcomeRea™ database from 1997 to 2020 (n=630 first ICU stays)

INTERVENTIONObservational study across three time periods (1997-2006, 2007-2015, 2016-2020) reflecting changes in ART availability and treatment guidelines

COMPARISONComparison across time periods of patient characteristics, HIV control, comorbidities, reasons for admission, and outcomes

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

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TL;DR

This 24-year French multicenter cohort study of 630 HIV patients admitted to ICUs found that while HIV control improved over time (higher CD4 counts, lower viral loads, increased ART use), patients were older and had more comorbidities. Despite these changes, 60-day mortality remained stable at approximately 22-19%, and AIDS status persisted as an independent predictor of mortality (HR 1.79, 95% CI 1.11-2.89). The findings highlight that improved HIV management has not translated into reduced ICU mortality, likely due to the offsetting effect of increased comorbidity burden.

Full summary

3,928 CHARS

**Background:** Despite antiretroviral therapy (ART), approximately 800,000 deaths from HIV occur globally each year. With improved virological control and aging of the HIV population, HIV-associated non-AIDS (HANA) conditions are increasingly observed. This study aimed to describe phenotypic changes in HIV patients admitted to ICUs from 1997 to 2020 and identify risk factors for 60-day mortality.

**Methods:** This was an analysis of prospectively collected data from the French OutcomeRea™ database, which includes 23 ICUs from university and non-university hospitals. All adult HIV patients with a first ICU stay between 1997 and 2020 were included. The study period was divided into three eras: 1997-2006 (pre-integrase inhibitor), 2007-2015 (integrase inhibitor availability), and 2016-2020 (universal ART recommendation). Patient characteristics, HIV-related data, ICU interventions, and outcomes were compared across periods. Multivariate Cox proportional hazards regression was used to identify predictors of 60-day mortality.

**Key Results:** Of 24,298 ICU stays, 630 (2.6%) were first ICU stays for HIV patients. The proportion of HIV admissions decreased significantly over time (3.2% to 2.3%, p=0.001). Median age increased from 41.8 to 54.3 years (p<0.001). Comorbidities increased significantly: diabetes (1.4% to 12.7%, p<0.001), obesity (2.5% to 15.2%, p<0.001), renal disease (3.3% to 8.9%, p=0.027), respiratory disease (1.9% to 10.1%, p=0.001), and solid neoplasia (0.5% to 8.9%, p<0.001). HIV control improved markedly: de novo HIV diagnosis on ICU admission decreased from 28.4% to 9.8% (p<0.001), ART coverage increased from 47.6% to 72% (p<0.001), median CD4 count rose from 223 to 324/mm³ (p=0.014), and median viral load decreased from 3.1 Log to 0 Log (p=0.004). The proportion of controlled HIV patients tripled from 22.4% to 56.3%. Active opportunistic infections at admission decreased from 36.2% to 24% (p=0.007). The main reasons for ICU admission remained stable: acute respiratory distress (35.6%), shock (18.7%), and coma (17.4%). Overall, 74.3% had confirmed AIDS, and 51% of admissions were for reasons not directly associated with HIV. ICU mortality (15.8% to 16.5%, p=0.992) and 60-day mortality (22.3% to 19%, p=0.382) remained stable. In multivariate analysis, independent predictors of 60-day mortality were: age >54 years (HR 1.47, 95% CI 0.91-2.36), chronic liver disease (HR 2.07, 95% CI 1.15-3.73, p=0.015), history of anticancer chemotherapy (HR 2.48, 95% CI 1.54-4.00, p<0.001), SOFA score >4 at admission (HR 2.35, 95% CI 1.56-3.56, p<0.001), pre-ICU hospitalization >24 hours (HR 1.47, 95% CI 1.03-2.11, p=0.033), and AIDS status (HR 1.79, 95% CI 1.11-2.89, p=0.017). The period of admission was not associated with mortality (p=0.578).

**Clinical Implications:** This study demonstrates that while HIV management in the ICU has improved substantially over 24 years—with better virological control, higher ART coverage, and fewer opportunistic infections—these gains have not translated into reduced mortality. The aging HIV population with increasing comorbidities (diabetes, obesity, organ diseases, malignancies) appears to offset the benefits of better HIV control. AIDS status remains a persistent independent risk factor for death, even in the modern ART era. The stability of modifiable risk factors (e.g., delayed ICU admission, severity at presentation) suggests opportunities for earlier identification and intervention in vulnerable HIV patients. The increasing use of anticancer chemotherapy in the ICU (from 1.4% to 12.7%, p<0.001) reflects the growing intersection of HIV, malignancy, and critical illness. Clinicians should maintain a low threshold for ICU admission in HIV patients with comorbidities and should not be reassured solely by good virological control, as AIDS status independently predicts worse outcomes regardless of ART status or viral load.

PICO

PPOPULATION

HIV-infected adult patients (≥18 years) admitted to ICU in French university and non-university hospitals participating in the OutcomeRea™ database from 1997 to 2020 (n=630 first ICU stays)

IINTERVENTION

Observational study across three time periods (1997-2006, 2007-2015, 2016-2020) reflecting changes in ART availability and treatment guidelines

OOUTCOME

60-day mortality; predictors of mortality including age, comorbidities, SOFA score, AIDS status, and period of admission

STUDY TYPE

cohort

SPECIALTY

infectious_disease

SUMMARISED BY

AI pipeline

FIDELITY CHECK

94% · A

ORIGINAL PAPER

PMC10012467

Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort

Critical Care

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ABSTRACT

Abstract Purpose Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. Methods HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. Results Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased—nonsignificantly—with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. Conclusion Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status. Keywords: Human immunodeficiency virus (HIV), Acquired immune deficiency syndrome (AIDS), Antiretroviral therapy (ART), Intensive care unit (ICU), Outcome assessment

CITATION EXPORT

Antoine Gaillet, Elie Azoulay, Etienne de Montmollin et al.. Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort. Critical Care. (2023). https://doi.org/10.1186/s13054-023-04325-9

AUTHORS

15 · 15 CENTRES

Antoine Gaillet, Elie Azoulay, Etienne de Montmollin, Maité Garrouste-Orgeas, Yves Cohen, Claire Dupuis, Carole Schwebel, Jean Reignier, Shidasp Siami, Laurent Argaud, Christophe Adrie, Bruno Mourvillier, Stéphane Ruckly, Jean-Marie Forel, Jean-Francois Timsit

1Medical Intensive Care Unit, Henri Mondor University Hospital, APHP, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France
2IAME UMR 1137, INSERM, Paris University, 75018 Paris, France
3Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris University, 1 Avenue Claude Vellefaux, 75010 Paris, France
4Medical Intensive Care Unit, Paris Diderot University/Bichat University Hospital, APHP, Paris, France
5Medical Unit, French-British Hospital Institute Levallois-Perret, Levallois-Perret, France
6Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Paris Seine Saint-Denis Hospital Network, APHP, Bobigny, France
7Medical Intensive Care Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France
8Nutrition Humaine Unit, INRAe, CRNH Auvergne, Clermont Auvergne University, 63000 Clermont-Ferrand, France
9Medical ICU, Albert Michallon University Hospital, Grenoble 1 University, Grenoble, France
10Medical ICU, Nantes University Hospital, Nantes, France
11Polyvalent ICU, Sud Essonne Dourdan-Etampes Hospital, Dourdan, France
12Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
13Polyvalent ICU, Delafontaine Hospital, Saint-Denis, France
14Medical Intensive Care Unit, Reims University Hospital, Reims, France
15Medical ICU, Hôpital Nord University Hospital, Marseille, France