Human immunodeficiency virus (HIV) co-infection does not worsen outcomes of sepsis in the setting of widely available combination antiretroviral therapy (cART), according to a study published in Critical Care.1
While modern HIV treatment has increased long-term survival among HIV-infected patients, sepsis is still a major cause of morbidity and mortality in this population. Historically, among patients with sepsis, mortality rates are higher in patients with advanced HIV infection than in HIV-negative patients. HIV co-infection may also alter the host immune response in sepsis, although this area has not been extensively evaluated.
Maryse A. Wiewel, MD, of the University of Amsterdam in the Netherlands, and colleagues investigated the effect of HIV co-infection on sepsis outcomes, as well as on the host immune response, in an area with ready access to HIV treatment.
Of 2251 (1889 patients) admissions for sepsis, 41 (32 patients) were associated with concurrent HIV infection. Pneumonia-related sepsis was more common among HIV-positive admissions than among HIV-negative admissions (73.2% vs 48.8%; P =.004).
Among most HIV-positive admissions, patients were already receiving HIV treatment with cART (70.7%). However, overt immune suppression with CD4 count <350 cells/mm3 was observed in the majority of HIV-positive admissions (73.2%).
Disease severity, measured as the proportion of patients with organ failure or shock, did not differ between HIV-positive and HIV-negative admissions. Mortality up to 1 year was also similar between the groups.
Host immune response was measured using biomarkers for vascular endothelium, cytokine network, and coagulation system activation and did not differ based on HIV infection status.
“[O]ur results indicate that in a high-resource setting with excellent access to care and HIV treatment, HIV infection has little, if any, influence on the clinical and pathophysiological course of sepsis requiring ICU admission,” the authors concluded. “These findings support the notion that the presence of HIV co-infection should not play a major role in the decision whether or not to admit critically ill patients with sepsis to the ICU.”
- Wiewel MA, Huson MA, van Vught LA,; MARS Consortium. Impact of HIV infection on the presentation, outcome and host response in patients admitted to the intensive care unit with sepsis; a case control study. Crit Care. 2016;20:322. doi: 10.1186/s13054-016-1469-0.