Temporal trends in critical events complicating HIV infection: 1999–2010 multicentre cohort study in France

Purpose Multicentre data are limited to appraise the management and prognosis of critically ill human immunodeficiency virus (HIV)-infected patients. We sought to describe temporal trends in demographic and clinical characteristics, indications for intensive care and outcome in this patient population. Methods We conducted a cohort study of unselected HIV-infected patients admitted between 1999 and 2010 to 34 French ICUs contributing to the CUB-Réa prospective database. Results We included 6,373 consecutive patients. Over the 12-year period, increases occurred in median age (39 years in 1999–2001; 47 years in 2008–2010, p < 0.0001) and prevalence of comorbidities (notably malignancies, from 6.7 to 16.4 %, p < 0.0001). Admissions for respiratory failure (39.8 % overall), shock (8.1 %) and coma (22.7 %) decreased ( p < 0.0001), while those for sepsis (19.3 %) remained stable. The main final diagnoses were bacterial sepsis (24.6 %) and non-bacterial acquired immune deficiency syndrome (AIDS)-defining diseases (steady decline from 26.0 to 17.5 %, p < 0.0001). Patients increasingly received mechanical ventilation (from 42.9 to 54.0 %) and renal replacement therapy (from 9.6 to 16.8 %) ( p < 0.0001), whereas vasopressor use remained stable (27.4 %). ICU readmissions increased after 2004 ( p < 0.0001). ICU and hospital mortality (17.6 and 26.9 %, respectively) dropped markedly in the most severely ill patients requiring multiple life-sustaining therapies. Malignancies and chronic liver disease were heavily associated with hospital mortality by multivariate analysis, while the most common AIDS-defining complications ( Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis and tuberculosis) had no independent impact. Conclusions Progressive ageing, increasing prevalence of comorbidities (mainly malignancies), a steady decline in AIDS-related illnesses and improved benefits from life-sustaining therapies were the main temporal trends in HIV-infected patients requiring ICU admission.