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Letter to the Editor
Reply to “Critically ill patients infected with HIV: 15 years of experience”
Respuesta a “Pacientes críticos infectados por VIH: 15 años de experiencia”
P. Vidal-Cortésa,
Corresponding author
pablo.vidal.cortes@sergas.es

Corresponding author.
, L. del Río-Carbajoa, Á. Castro-Iglesiasb
a Intensive Care Unit. Complexo Hospitalario Universitario de Ourense (CHUO), Spain
b Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INBIC) – Complexo Hospitalario Universitario de A Coruña (CHUAC), Universidade de A Coruña, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank Dr&#46; Agrifoglio et al&#46; for their comments&#44; which come to complement and reinforce our conclusions&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> There is currently no discussion that the decision for admission to the ICU of patients infected with HIV&#44; as in other patients with other chronic diseases&#44; should be individualized and that a large percentage of these patients may benefit from intensive treatment&#44; including all necessary support measures&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although&#44; apparently&#44; the reasons for admission in our series seem different&#44; both coincide in pointing out the importance of receiving or not receiving HAART at the time of admission&#44; in addition to being aware of the infection or not&#44; not to predict the prognosis&#44; but as an aid to establish the diagnosis of the pathology that causes ICU admission&#46; Agrifoglio et al&#46; report that 70&#37; of patients who were aware of their infection were admitted due to a non-AIDS-related pathology and we observed that sepsis caused 63&#37; of ICU admissions in patients who were not receiving HAART&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As we say&#44; HIV infection has become a chronic disease&#44; but that does not mean that its study within critical pathology has lost interest&#44; as evidenced by two recent reviews published in high impact journals&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> Both summarize the differential diagnosis&#44; based on the immunological status&#44; of the main reasons for admission to the ICU of these patients&#58; acute respiratory failure and altered consciousness&#44; which can be challenging&#44; especially in the most immunosuppressed patients&#46; Another unresolved challenge they address is identifying the best time to start antiretroviral treatment&#44; especially in patients who do not receive it and who are admitted to the ICU as a consequence of an opportunistic infection&#46; In the reviews mentioned above&#44; the authors give their expert recommendation and suggest that this is a possible area of research for the future&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Like Agrifoglio&#44; the two reviews mention the importance of improving the knowledge of the outcome of these patients&#44; they are more focused on the impact of ICU admission on the long-term outcome and Agrifoglio et al&#46; is more focused on the selection of which patients will benefit from more aggressive measures&#46; Even when we analyze the cohort studies published since 2005 &#40;as Azoulay et al&#46; did&#41;&#44; we find that ICU mortality varies from 14 to 66&#37;&#44; a margin too wide to make decisions and inform the patient or family of the chances of survival&#46; As Agrifoglio et al&#46;&#44; who mention the combination of the stage of the HIV infection&#44; the reason for admission and the accompanying medical factors to better predict the outcome&#44; we believe that the combination of demographic variables&#44; comorbidities&#44; nutritional and immune status&#44; reason for admission&#44; and need for organic support in the first 72<span class="elsevierStyleHsp" style=""></span>h of admission could be useful in developing a prognostic score that predicts hospital mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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