hiv and intensive care by mark thomas
TRANSCRIPT
1. A S S O C . P R O F . M A R K T H O M A S I N T E N S I V E C A R E N E T W O R K N Z : A U C K L A N D J U N E 2 0 1 5 HIV AND THE ICU 2. HAS HIV INFECTION GONE AWAY? NO! 3. BUT AIDS AND DEATH HAVE LARGELY GONE AWAY. 4. DIAGNOSED VS UNDIAGNOSED HIV IN NZ? February 2011 Big Gay Out, 3 gay bars, 4 sex on site venues 3791 invitations 1318 respondents (48.5%) 68/1049 (6.5%) respondents HIV antibody (saliva) +ve 53/67 (79%) men known HIV infection 14/67 (21%) men not known HIV infection Saxton P et al. BMC Pub Health 2012;12:92 5. DIAGNOSED HIV INFECTION Proportion HIV +ve Gay men 7% African men and women 2% (?) Injecting drug users 1-2% Total population 1 in 2,000 Approx 80% with diagnosed HIV infection are on treatment 6. AIDS AND DEATH WENT AWAY DUE TO AN EVENTUAL ABUNDANCE OF ANTIRETROVIRAL AGENTS AZT DDI, DDC 3TC, D4T abacavir TDF, FTC nevirapine efavirenz Indinavir, ritonavir, saquinavir atazanavir darunavir 7. SIMPLE ANTIRETROVIRAL TREATMENT REGIMENS READILY CONTROL HIV INFECTION AND ALLOW IMMUNE RECOVERY Truvada + Nevirapine 8. HIV DRUG RESISTANCE TESTING ALLOWS SELECTION OF EFFECTIVE ART COMBINATIONS 9. THERE ARE USUALLY ENOUGH ANTIRETROVIRAL AGENTS FOR MOST PEOPLE TO HAVE 3-4 BITES AT THE CHERRY, AND VERY FEW PATIENTS HAVE UNCONTROLLABLE INFECTION SO FAR. Truvada + Nevirapine Darunavi r ritonavir Raltegra vir Combivir 10. ICU ADMISSIONS AIDS illnesses (low CD4, high HIV viral load) respiratory usually PCP neurological usually toxoplasmosis or lymphoma, or cryptococcal Other conditions (high CD4 low HIV viral load) cardiovascular, malignancy, etc 11. GOOD OUTCOME IN PATIENTS WITH SEVERE INFLUENZA AND UNTREATED HIV INFECTION, TREATED WITH PROLONGED ECMO. CONNELL H, GILHAM M, MCKEE A, MCGUINESS S. LANCET INTENSIVE CARE 2013;6:697-803 12. Confirmed occupationally acquired HIV infection 1985-2013 MMWR January 2015 Lab technician needle puncture HIV culture! 13. HIV DIAGNOSIS Screening test by ELISA if urgent request quantitative result within hours Confirmatory test either Western blot or HIV viral load result of either takes a few days CD4 count same day 14. SIMPLE ANTIRETROVIRAL TREATMENT REGIMENS READILY CONTROL HIV INFECTION AND ALLOW IMMUNE RECOVERY Truvada + Nevirapine