USO DE ANTIRETROVIRAL EM PACIENTES SIDA CRITICAMENTE ENFERMOS

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit.

Critical Care Medicine. POST COPYEDIT, 25 March 2009. Croda, Julio MD; Croda, Mariana Garcia MD; Neves, Alan MD; dos Santos, Sigrid De Sousa MD, PhD

Quando eu era residente de terapia intensiva, lembro-me que, sempre que um paciente com SIDA em uso de anti-retroviral (ARV) internava no CTI, havia a mesma discussão: é melhor manter o anti-retroviral, já que a internação está diretamente relacionada a complicação do HIV, ou suspendê-lo, pois no paciente grave a absorção do ARV é errática e pode contribuir para indução de resistência do vírus?

Este artigo, publicado pelo grupo da USP, propõe-se a responder essa questão. Eles estudaram 278 pacientes infetados pelo HIV que internaram na terapia intensiva e concluiram que o uso de ARV, principalmente quando instituído nos primeiros 4 dias de internação no CTI, está associado a maior sobrevivência em 6 meses. Mesmo em pacientes que não utilizavam ARV, a sua instituição na terapia intensiva está associado a menor mortalidade a longo prazo.

Cássia Righy

na revista THORAX desse mês...Survival of HIV-infected patients in the intensive care unit in the era of highly active antiretroviral therapy

Thorax 2007;62:964-968

Survival of HIV-infected patients in the intensive care unit in the era of highly active antiretroviral therapy
S J Dickson1, S Batson2, A J Copas3, S G Edwards4, M Singer2, R F Miller3

Background: Several studies have described improved outcomes for HIV-infected patients admitted to the intensive care unit (ICU) since the introduction of highly active antiretroviral therapy (HAART). A study was undertaken to examine the outcome from the ICU for HIV-infected patients and to identify prognostic factors.

Methods: A retrospective study of HIV-infected adults admitted to a university affiliated hospital ICU between January 1999 and December 2005 was performed. Information was collected on patient demographics, receipt of HAART (no patient began HAART on the ICU), reason for ICU admission and hospital course. Outcomes were survival to ICU discharge and to hospital discharge.

Results: 102 patients had 113 admissions to the ICU; HIV infection was newly diagnosed in 31 patients. Survival (first episode ICU discharge and hospital discharge) was 77% and 68%, respectively, compared with 74% and 65% for general medical patients. ICU and hospital survival was 78% and 67% in those receiving HAART, and 75% and 66% in those who were not. In univariate analysis, factors associated with survival were: haemoglobin (OR = 1.25, 95% CI 1.03 to 1.51, for an increase of 1 g/dl), CD4 count (OR = 1.59, 95% CI 0.98 to 2.58, for a 10-fold increase in cells/µl), APACHE II score (OR = 0.51, 95% CI 0.29 to 0.90, for a 10 unit increase) and mechanical ventilation (OR = 0.29, 95% CI 0.10 to 0.83).

Conclusions: The outcome for HIV-infected patients admitted to the ICU was good and was comparable to that in general medical patients. More than a quarter of patients had newly diagnosed HIV infection. Patients receiving HAART did not have a better outcome.