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HIV, ART, and the ICU
- Though survival has dramatically improved for patients with HIV, there has been no decrease in the quantity of ICU admissions for this select patient population.
- One of the most common reasons for ICU admission is now adverse effects of antiretroviral therapy (ART).
- When managing a critically ill HIV patient in the ED or ICU, consider the following effects of ART as an etiology:
- Lactic acidosis
- Seen with nucleoside reverse transcriptase inhibitors (NRTIs): greatest risk with didanosine, stavudine, and zidovudine
- Presentation: fatigue, malaise, vomiting, abdominal pain, hepatomegaly
- Lactate often > 10 mmol/L
- Abacavir hypersensitivity
- Usually within first 6 weeks of drug initiation
- Presentation: rash, fever, shortness of breath, vomiting, abdominal pain
- Can rapidly progress to cardiovascular collapse
- Lactic acidosis
References
Tan DHS, Walmsley SL. Management of persons infected with human immunodeficiency virus requiring admission to the intensive care unit. Crit Care Clin 2013; 29:603-20.