30-year study explores critical illness trends in people with advanced HIV disease

Encouraging trends on intensive care unit (ICU) admissions and mortality rates among people with advanced HIV are tempered by signs of greater severity and complexity of illness in admitted patients, according to a recently published three-decade review of data from Australia and New Zealand. Among other lessons, the findings give us an important reminder that, even when our HIV treatment and medical care tools are as good as they’ve ever been, there is still a subset of patients who are entering care quite late.

Highlighted Study Population and Methods

This study utilized the Australian and New Zealand Intensive Care Society-Adult Database (ANZICS-APD), a database of admissions, demographics, primary diagnoses, comorbidities, and mortality. Data were obtained during an impressively long 30-year period between 1993 and 2022.

The cohort comprised individuals over age 16 with a comorbid diagnosis of advanced HIV disease (AHD; requiring a HIV diagnosis and AIDS-defining illness). Only first ICU admission events were included. The authors evaluated trends in patient characteristics, interventions, and outcomes over each of the three decades.

Key Findings

• In total, there were 1,505 ICU admissions of individuals with advanced HIV disease that qualified for inclusion in the study.

• From the first decade to the third, the median patient age increased from 41 to 53 years (p=<0.001).

• The proportion of ICU admissions with one or more chronic comorbidities increased over time (18% versus 26%, p=0.006).

• The Sequential Organ Failure Score, reflecting of ICU mortality risk, also increased significantly (median 3 to 4, p=<0.001).

• Infections (particularly respiratory infections) were a frequent indication for ICU admissions throughout the study. However, their proportion decreased from 28% in 1993-2002 to 15% in 2013-2022 (p=<0.001).

• Conversely, post-surgical admissions increased from 11% to 26% over the same period, driven in part by an increase in cardiovascular surgical admissions.

• Notably, in-hospital mortality declined substantially from 36% in 1993-2002 to 14% in 2013-2022 (p<0.001), even after adjusting for illness severity and type of hospital. That said, overall ICU mortality for the general population was 6%.

Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodyPro.