Pacientes con infección por VIH/SIDA en una Unidad de Pacientes Críticos. La experiencia de un hospital general en un país en desarrollo

Introduction and aims: Despite general availability of HAART in Chile, admissions of HIV/AIDS patients to Intensive-Intermediate Care Units (IICU) are still happening, and a characterization of patient´s profile, mortality and potentially avoidable admissions is necessary. Methods: Observational retrospective study in one general hospital in Chile of HIV/AIDS patients admitted to IICU during 9 years. Results: During 2005-2013, 32 patients were admitted to IICU, with 87.5% in AIDS stage, only 53.1% knew his/her condition, 43,8% were receiving HAART and 16.6% chemoprophylaxis for opportunistic infections. A CD4 count < 200/μL was registered in 75.9% of patients. Most admissions were driven by infectious conditions (84.4%) and 48.1% developed septic shock. IICU hospitalizations were motivated by respiratory failure, neurologic compromise, sepsis or a mixture of them (87.5%). By univariate analysis, admissions by respiratory failure were associated to no HAART, oral candidiasis or CD4 < 250/μL (p < 0.01). Eight patients died during their first hospitalization (25%) and other 5 in the following month after discharge. Death during hospitalization was significantly associated to vasoactive drug use ≥ 7 days (OR 16.5; IC95 2.1-128 p < 0.01). In multivariate analysis, APACHE score ≥ 18 was associated with death during hospitalization of after discharge (OR 3.3 IC95 1.1-10; p < 0.05). Four patients (12.5%) had potentially avoidable admissions. Conclusions: Despite HAART availability in Chile, hospitalizations of patients with HIV/AIDS are still happening, affecting those that either are unaware of his/her condition, are not receiving HAART and/or chemoprophylaxis. These admissions generate premature deaths and happen even after discharge in severely ill patients.