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Vol. 45. Núm. 7.
Páginas 442-443 (Octubre 2021)
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Vol. 45. Núm. 7.
Páginas 442-443 (Octubre 2021)
Letter to the Editor
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Critically ill patients infected with HIV: 15 years of experience
Pacientes críticos infectados por VIH: 15 años de experiencia
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A. Agrifoglio Rotaeche
Autor para correspondencia
alexander_agrifoglio@yahoo.es

Corresponding author.
, L. Cachafeiro Fuciños, M. Hernández Bernal, A. García de Lorenzo y Mateos
Servicio de Medicina Intensiva, Hospital Universitario La Paz/Carlos III/IdiPAZ, Paseo de la Castellana 264, 28046 Madrid, Spain
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Dear Editor,

Infection with the human immunodeficiency virus (HIV) constitutes one of the main public health problems in the world. The use of prophylaxis against opportunistic infections and, especially, the introduction of highly active antiretroviral treatment (HAART) in late 1996 has increased the life expectancy of these patients and has eventually been followed by a marked decrease in the morbidity and mortality associated with this disease1,2.

We have carefully read the article published by P. Vidal-Cortés et al.3 and we want to congratulate the authors for such a large and important series of patients studied. One of the limitations referred to in the original article is the difficulty in generalizing the results, since it was only performed in the ICUs of two hospital centers. Given this, we wish to contribute our experience in a work in which we obtained similar results to those presented by the authors and that we published in the XLVII SEMICYUC National Congress eight years ago4.

Our series of patients was also analyzed and studied retrospectively over a period of 15 years (1995–2009). During this period of time, 188 HIV patients was admitted to the ICU, representing 1.5% of total admissions. Of all the different variables analyzed, we believe that perhaps we should stick to the fact that the first three causes of admission were respiratory failure, neurological pathology in relation to coma due to toxic consumption and septic shock. 16.5% of the patients were unaware of the infection at the time of admission, 44% did not receive HAART. In the group of patients in whom HIV infection was not known, 93.5% were admitted due to pathology related to it, while in the group of patients with known infection, the admission pathology was not related to the disease in 70%.

We recognize that there are two databases with enormous potential for epidemiological and clinical information that undoubtedly provide a large number of conclusions. Like the authors, we share the opinion that the use of therapeutic resources offered in ICUs for HIV-infected patients has been a matter of controversy since the first cases of the disease were described, sparking great medical debate, ethical and economic in relation to the application of critical therapy to these patients. However, the introduction of HAART has not only significantly improved the quality of life and survival of the patients as mentioned above, but has also changed both the reason and the criteria for admission to these Units.

Therefore, we wish to support and consolidate the conclusion that people with HIV infection can and should benefit from the reasonable and individualized use of care in an ICU where they receive all the necessary measures for its stabilization and treatment. The correct information to the patient and his family, together with the adequate evaluation of each individual patient, the stage of the disease, the reason for admission and the accompanying medical factors should be considered as determining the attitude of the Intensivist.

Author's contributions

Alexander Agrifoglio conceived the letter and drafted the manuscript. Lucía Cachafeiro, Mónica Hernández and Abelardo García de Lorenzo drafted the manuscript. All authors read and approved the final manuscript.

Funding

None declared.

Competing interests

The authors declare that they have no competing interests.

Acknowledgment

To the memory of Dr. María Antonia Arce, who contributed to the design and execution of the original communication.

References
[1]
A. Corona, F. Raimondi.
Caring for HIV-infected patients in the ICU in the highly active antiretroviral therapy era.
Curr HIV Res, 7 (2009), pp. 569-579
[2]
K. Akgün, L. Huang, A. Morris, A.C. Justice, M. Pisani, K. Crothers.
Critical illness in HIV-infected patients in the era of combination antiretroviral therapy.
Proc Am Thorac Soc, 8 (2011), pp. 301-307
[3]
P. Vidal-Cortés, L.A. Álvarez-Rocha, P. Fernández-Ugidos, M.A. Pérez-Veloso, I.M. Suárez-Paul, A. Virgós-Pedreira, et al.
Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era.
Med Intensiva, 44 (2020), pp. 283-293
[4]
A. Agrifolio, M.A. Arce, M. Oliveros, J.I. Bernardino, M. Jiménez.
Perfil de los infectados por VIH en la UVI de un Hospital Terciario. Quince años de experiencia: 1995-2009.
Poster presented in: XLVII Congreso Nacional de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), Santander, España, 2012 Jun 10-13, 36 (2012), pp. 145
Copyright © 2020. Elsevier España, S.L.U. y SEMICYUC
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