Managing Modern Antiretroviral Therapy in the Intensive Care Unit: Overcoming Challenges for Critically Ill People With Human Immunodeficiency Virus

Daniel B Chastain; Patrick J Tu; Marisa Brizzi; Chelsea A Keedy; Aubrey N Baker; Brittany T Jackson; Amber F Ladak; Leslie A Hamilton; Nicholas R Sells; Andrés F Henao-Martínez; Kathleen A McManus; David B Cluck

doi:10.1093/ofid/ofae213

Managing Modern Antiretroviral Therapy in the Intensive Care Unit: Overcoming Challenges for Critically Ill People With Human Immunodeficiency Virus

Open Forum Infect Dis. 2024 Apr 17;11(5):ofae213. doi: 10.1093/ofid/ofae213. eCollection 2024 May.

Authors

Affiliations

¹ Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA.
² Department of Pharmacy, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA.
³ Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
⁴ Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, Georgia, USA.
⁵ Department of Pharmacy, Mount Sinai Morningside, New York, New York, USA.
⁶ Division of Infectious Diseases, Augusta University, Augusta, Georgia, USA.
⁷ College of Pharmacy, University of Tennessee Health Science Center, Knoxville, Tennessee, USA.
⁸ Division of Infectious Diseases, Mount Sinai Morningside, New York, New York, USA.
⁹ Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA.
¹⁰ Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
¹¹ Department of Pharmacy, University of Virginia Health, Charlottesville, Virginia, USA.

Abstract

People with human immunodeficiency virus (HIV) have a 50% excess risk for intensive care unit (ICU) admission, often for non-HIV-related conditions. Despite this, clear guidance for managing antiretroviral therapy (ART) in this setting is lacking. Selecting appropriate ART in the ICU is complex due to drug interactions, absorption issues, and dosing adjustments. Continuing ART in the ICU can be challenging due to organ dysfunction, drug interactions, and formulary limitations. However, with careful consideration, continuation is often feasible through dose adjustments or alternative administration methods. Temporary discontinuation of ART may be beneficial depending on the clinical scenario. Clinicians should actively seek resources and support to mitigate adverse events and drug interactions in critically ill people with HIV. Navigating challenges in the ICU can optimize ART and improve care and outcomes for critically ill people with HIV. This review aims to identify strategies for addressing the challenges associated with the use of modern ART in the ICU.

Keywords: HIV infections; HIV integrase inhibitors; antiretroviral agents; critical care; intensive care units.

Publication types

Review