Intensive care of patients with HIV infection

Antiretroviral therapy has increased the life expectancy of patients who are infected with the human immunodeficiency virus (HIV) and has reduced the incidence of illnesses associated with the acquired immunodeficiency syndrome (AIDS). However, the frequency of pulmonary, cardiac, gastrointestinal, and renal diseases that are often not directly related to underlying HIV disease has increased.1-4 Although the guiding principles of management in the intensive care unit (ICU) pertain to critically ill patients with HIV infection, antiretroviral therapy and unresolved questions regarding its use in the ICU add an additional level of complexity to already complicated cases. This review focuses on some of the important clinical problems related to the use of antiretroviral therapy in critically ill patients with HIV infection and on the challenging issues associated with the intensive care of such patients, including legal statutes concerning HIV testing and disclosure, the administration of antiretroviral medications, important potential drug interactions with medications commonly used in the ICU, and controversies surrounding the use of antiretroviral therapy in the ICU. Copyright © 2006 Massachusetts Medical Society.