The following is a summary of “ONE-YEAR MORTALITY OF PEOPLE WITH HIV AFTER INTENSIVE CARE UNIT ADMISSION”, presented by Nicholas Bakewell, Caroline Sabin, Tanmay Kanitkar, Maggie Symonds, Oshani Dissanayake, Stephanie Rimmer, Amit Adlakha, Marc Lipman, Sanjay Bhagani, Banwari Agarwal, Robert Miller.

Opportunistic infections and critical illness remain common among people living with HIV (PWH), increasing their risk of and mortality following intensive care unit (ICU) admission. It is difficult to draw conclusions from the scant information available in the literature about the mortality rate both before and after patients leave the intensive care unit. Researchers report on the changing patterns of 1-year mortality among PWH (>18 years) admitted to an HIV-referral center’s intensive care unit between 2000 and 2019. Mortality at 1 year was determined from the date of index ICU admission to the date of death; follow-up was right-censored at day 365 if the individual was known to remain alive at 1 year, or day 7 after ICU discharge if the person was known to be alive at hospital discharge but lost to follow-up. Kruskal Wallis and Cochrane Armitage tests and Kaplan-Meier and log-rank tests were used to examine variations in baseline characteristics between groups for each calendar year (2000-2003, 2004-2007, 2008-2011, 2012-2015, 2016-2019).

Associations with calendar year (as a continuous covariate) were characterized using Cox regression analysis, both before and after adjusting for age, sex, APACHE II score, CD4+ T-cell count, and time since HIV diagnosis at the time of ICU admission (within 3 months of ICU admission). In total, 221 PWH were hospitalized to the intensive care unit (72% male, median [IQR] age 45 [38-53] years), and 108 of them died within a year (median survival: 349 days, cumulative 1-year survival: 50%). Compared to those admitted in earlier years, those admitted in later years had a lower median admission APACHE II (29, 25, 17, 14, 13 respectively, P<0.001), were older (medians of 40, 44, 44, 46, 49 years, respectively, P=0.03), had a higher median CD4+ T-cell count (98, 52, 169, 212, 128 cells/ mm3, P=0.002), a lower percentage with advanced HIV (CD4+ T-cell count < 200 cells/mm3 and/or AIDS at admission to ICU; 95, 77, 66, 50, 66%, P=0.01), and a greater percentage with HIV-RNA LESS THAN 50 copies/mL (17, 34, 59, 46, 53%, P=0.02).

The cumulative survival rate improved with increasing age (P=0.001, log-rank test), and the risk of dying within a year decreased by 9% for each additional year of age (hazard ratio [HR]: 0.89, 95% CI: 0.87-0.93). After accounting for confounders, the rate of decline in yearly mortality was lowered to 7% each year (adjusted HR: 0.93 (95% CI: 0.89-0.98)). The ICU saw a decrease in mortality rates one year following ICU admission. Although replication in other ICUs is necessary, the results highlight the importance of ensuring that PWH continue to receive the care they require even after they leave the hospital.