Critical Care Management in HIV-Infected Patients

Advances in antiretroviral therapy have transformed the profile of HIV-infected patients requiring intensive care, shifting the focus from opportunistic infections to chronic comorbidities and organ dysfunction. In contemporary practice, early recognition of sepsis, prompt initiation or continuation of antiretroviral regimens and vigilant management of respiratory failure are central to improving outcomes. Mechanical ventilation strategies tailored to immunocompromised lungs, stringent infection control and optimisation of haemodynamic support underpin daily care. The emergence of non-AIDS conditions—including cardiovascular disease, malignancies and renal impairment—necessitates a multidisciplinary approach encompassing infectious disease specialists, intensivists and oncologists. Resource allocation and triage decisions must balance prognosis with patient autonomy, particularly where treatment limitation discussions arise. With global disparities in access to high-quality critical care, strategies developed in high-income settings are being adapted for resource-limited environments, emphasising task-sharing, rapid diagnostics and simplified antiretroviral delivery. At a systems level, integration of intensive care units into HIV care networks enhances continuity of antiretroviral therapy and reduces delays in admission. Ongoing challenges include management of acute respiratory distress syndrome in patients with low CD4 counts, prevention of drug–drug interactions in polypharmacy and mitigation of long-term sequelae in survivors.

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Critical Care Management in HIV-Infected Patients publication trend

The graph below shows the total number of articles in critical care management in hiv-infected patients across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral therapy (ART): Combination of medications that inhibit HIV replication and reduce viral load.

Highly active antiretroviral therapy (HAART): Potent multi-drug ART regimens designed to achieve sustained virological suppression.

Human immunodeficiency-associated non-AIDS conditions (HANA): Chronic comorbidities, such as cardiovascular and renal disease, emerging despite controlled HIV.

Acute respiratory distress syndrome (ARDS): Severe inflammatory lung injury characterised by hypoxaemia and bilateral infiltrates.

Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Opportunistic infection: Infection by pathogens that exploit weakened immunity in HIV-infected hosts.

References

1. Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort. Critical Care (2023).
2. Clinical spectrum and prognostic impact of cancer in critically ill patients with HIV: a multicentre cohort study. Annals of Intensive Care (2023).
3. Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital. Viruses (2023).