Sepsis in HIV-positive patients. What is the scale of the problem and how to approach it?

Abstract

In the antiretroviral therapy (ART) era, human immunodeficiency virus (HIV)-positive patients are admitted to the hospital in a critical state for various reasons, with a decrease of hospitalizations due to opportunistic infections. About 12-31% of hospitalizations of HIV-infected patients in the intensive care unit (ICU) are due to sepsis. HIV-positive patients with sepsis have a higher mortality rate than HIV-negative patients. Although there are no specific recommendations on how to treat septic HIV-positive patients, it is important to remember which pathogens are the most common causes of infection in this group of patients. More attention should be drawn to nosocomial infections mainly caused by Gram-positive cocci and Gram-negative rods. According to the European AIDS Clinical Society Guidelines (EACS) 2015, ART should be introduced in all HIV-positive patients, regardless of the CD4 cell count. The recommendations do not contain information on treatment of patients with HIV with sepsis. The introduction of ART in HIV-positive patients in a critical state is still debatable due to the drug-drug interactions and route of administration. Though ART in critically ill patients may not affect the hospital survival, it has long-term benefits such as fewer AIDS-related events. The aim of this article was to provide physicians with an overview of recent information on patients with HIV who develop sepsis.