Changes in short-term (in-ICU and in-hospital) mortality following intensive care unit admission in adults living with HIV: 2000–2019

Abstract

Objective: Limited data suggest intensive care unit (ICU) outcomes have improved in people with HIV (PWH). We describe trends in in-ICU/in-hospital mortality among PWH following admission to ICU in a single UK-based HIV referral centre, from 1 January 2000 to 31 December 2019. Methods: Modelling of associations between ICU admission and calendar year of admission was done using logistic regression with adjustment for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, CD4+ T-cell count and diagnosis of HIV at/within the past 3 months. Results: Among 221 PWH (71% male, median [interquartile range (IQR)] age 45 years [38–53]) admitted to ICU, median [IQR] APACHE II score and CD4+ T-cell count were 19 [14–25] and 122 cells/μl [30–297], respectively; HIV-1 viral load was ≤50 copies/ml in 46%. The most common ICU admission diagnosis was lower respiratory tract infection (30%). In-ICU and in-hospital, mortality were 29 and 38.5%, respectively. The odds of in-ICU mortality decreased over the 20-year period by 11% per year [odds ratio (OR): 0.89 (95% confidence interval (CI): 0.84–0.94)] with in-hospital mortality decreasing by 14% per year [0.86 (0.82–0.91)]. After adjusting for patient demographics and clinical factors, both estimates were attenuated, however, the odds of in-hospital mortality continued to decline over time [in-ICU mortality: adjusted OR: 0.97 (0.90–1.05); in-hospital mortality: 0.90 (0.84–0.97)]. Conclusion: Short-term mortality of critically ill PWH admitted to ICU has continued to decline in the ART era. This may result from changing indications for ICU admission, advances in critical care and improvements in HIV-related immune status.