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Báo cáo y học: " Continuing HIV therapy in the ICU"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Continuing HIV therapy in the ICU. | Available online http ccforum.eom content 5 5 247 Commentary Continuing HIV therapy in the ICU Neil Soni and Anton Pozniak Chelsea Westminster NHS Trust London UK Correspondence Neil Soni n.soni@ic.ac.uk Published online 13 September 2001 Critical Care 2001 5 247-248 2001 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract The risks and benefits of stopping antiretroviral therapy in patients admitted to the ICU are largely unmeasured. In many cases therapy has to be stopped as parenteral preparations are unavailable for all but one of the antiretroviral agents. Stopping treatment suddenly may be associated with increased risk of resistance because of the long half-life of some of the drugs and also the risk of increased immunosuppression due to the viral load rebounding. Drugs given through the enteral route may be poorly absorbed which again may lead to drug resistance. By inhibiting cytochrome P450 3A4 the drugs interfere with the metabolism of many other compounds routinely used in the ICU. Furthermore the drugs themselves are occasionally associated with severe toxicity such as pancreatitis and lactic acidosis which can have devastating consequences. Much active research in all of these areas is now needed. Keywords drugs HAART HIV ICU pharmacokinetics The widespread introduction of highly active antiretroviral therapy HAART in 1996 has revolutionised the prognosis of HIV disease 1-3 . The incidence of death from AIDS has fallen markedly and many opportunistic infections have become relatively rare. Consequently the pattern of referrals to the intensive care unit ICU has altered. It is important to appreciate however that in spite of advances in treatment 30 of new HIV diagnoses are made when patients are already severely immunocompromised the patient may be presenting with AIDS for the first time 4 . A dilemma arises when a patient on HAART is admitted to the ICU. Unless the admission is directly related to HAART there is little consensus on