Analysis of the effectiveness of antiretroviral therapy in patients in intensive care unit
AbstractThe article presents the results of the analysis of the effectiveness of antiretroviral therapy in patients of the intensive care unit (ICU) for HIV-infected patients, created on the basis of the Infectious Diseases Clinical Hospital No. 2 in Moscow.
The aim: to study the effectiveness of ART in HIV-infected patients admitted to the intensive care unit of an infectious hospital (ICU).
Method and materials. Clinical and epidemiological data of 169 HIV patients admitted to the ICU were analyzed. Patients were divided into 2 groups: 103 patients in the first group already initiated antiretroviral therapy (ART) before hospitalization, while 66 naive patients in the second initiated during hospitalization. Clinical improvement in the ICU and transfer to continued care on general wards implied clinical effectiveness of treatment. The "laboratory" effectiveness was evaluated on the basis of the results of molecular biological and immunological studies.
Results. Two NRTIs plus PI were the most used regimen in the groups (51.6% in group 1, 83.3% in group 2). Cytomegalovirus (CMV) emerged as the most common opportunistic (30.1% in group 1, 62.12% in group 2). Immunological and virologic status of the studied groups were as follow: 889 166±213 484 HIV-1 RNA copies/mL in group 1 and 481 075±179 810 HIV-1 RNA copies/mL in group 1; CD4+ 171.72±22.74 cells/mm3 in group 1 and 98.18±17.26 cells/mm3 in group 2. Patient survival rate was 19.42% in the group 1 and 31.82% in the group 2. Patients in the group 1 receiving 2 NRTIs in combination with Atazanavir had a good clinical outcome (p<0.01). 26% patients in the first group had undetectable HIV RNA levels, 25% in the same group had detected levels between 20-1000 copies/ml. 91% patients in group 2 had exceeding levels of HIV viral load which correlates with the natural course of the disease. Zero CD4-cell counts were recorded 5.7 times more in the group 2.
Conclusion. Our study demonstrates a significant difference between the viral load indicators in the comparison groups. The immunological characteristics also had significant differences. A poor clinical efficacy of ART is attributed to late initiation and short duration due to disease severity which lead to deaths in infected patients.
Keywords:HIV-infection, antiretroviral therapy, intensive care unit
Funding. The publication was prepared with the support of the Strategic Academic Leadership Program of the People's Friendship University of Russia (RUDN University).
Conflict of interest. The authors declare that there is no conflict of interest.
Contribution. Research concept and design - Voznesenskiy S.L., Kozhevnikova G.M.; collection and processing of material - Voznesenskiy S.L., Petrova E.V., Klimkova P.V., Tishakova D.A.; statistical processing - Voznesenskiy S.L., Ermak T.N.; text writing - Voznesenskiy S.L., Ermak T.N., Kravchenko A.V.; editing - Kozhevnikova G.M., Ermak T.N., Kravchenko A.V.; approval of the final version of the article - Voznesenskiy S.L., Petrova E.V., Kozhevnikova G.M., Ermak T.N., Kravchenko A.V.; responsibility for the integrity of all parts of the article - Voznesenskiy S.L.
For citation: Voznesenskiy S.L., Petrova E.V., Kozhevnikova G.M., Ermak T.N., Kravchenko A.V., Klimkova P.V., Tishakova D.A. Analysis of the effectiveness of antiretroviral therapy in patients in intensive care unit. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2021; 10 (4): 59-65. DOI: https://doi.org/10.33029/2305-3496-2021-10-4-59-65 (in Russian)
REFERENCES
1. Pokrovsky V.V., Yurin O.G., Kravchenko A.V., Belyaeva V.V., et al. National recommendations for dispensary follow-up and treatment of patients with HIV infection 2017. Clinical Protocol. Epidemiologiya i infektsionnye bolezni. Aktual’nye voprosy [Epidemiology and Infectious Diseases. Actual Issues]. 2017; 6 (suppl): 80 p. (in Russian)
2. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Developed by the panel on clinical practices for treatment of HIV infection convened by the Department of Health and Human Services (DHHS). AIDS Info. August 01, 2019. URL: http://www.AID-Sinfo.nih.gov/guidelines
3. EACS Guidelines. Version 9.1. October 2018: 103 p. URL: http://www.eacsociety
4. Pokrovsky V.V., Yurin O.G., Kravchenko A.V., Belyaeva V.V., Buravtsova E.V., Deulina M.O., et al. Recommendations for the treatment of HIV infection and related diseases, chemoprophylaxis of HIV infection. Epidemiologiya i infektsionnye bolezni. Aktual’nye voprosy [Epidemiology and Infectious Diseases. Actual Issues]. 2019; 4 (suppl): 87 p. (in Russian)
5. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. 2nd ed. WHO, June 2016: 480 р. URL: http://www.who.int/hiv
6. HIV and AIDS: a national guide. Eds by V.V. Pokrovsky. 2nd ed. revised and additional. Moscow: GEOTAR-Media, 2020: 696 p. DOI: https:// doi.org/10.33029/9704-5421-3-2020-VIC-1-696 (in Russian)
7. Musatov V.B., Yakubenko A.L., Tyrgina T.V. Late-detected cases of HIV infection among hospitalized patients. VICH infektsiya i immunosu-pressii [HIV Infection and Immunosuppression]. 2010; 2 (3): 88-90. (in Russian)
8. Shakhgil’dyan V.I. Palliative care for patients with HIV infection as an integral part of the general system of palliative medicine and rehabilitation. Palliativnaya meditsina i reabilitatsiya [Palliative Medicine and Rehabilitation]. 2019; (2): 13-21. (in Russian)
9. Leonova O.N., Stepanova E.V., Belyakov N.A. Severe and comorbid conditions in patients with HIV infection: an analysis of adverse outcomes. VICH infektsiya i immunosupressii [HIV Infection and Immunosuppression]. 2017; 9 (1): 55-64. (in Russian)