Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android



  • Combination antiretroviral therapy (cART) has been shown to prolong survival and disease-free interval. Interruption in adherence to treatment is a major risk for opportunistic infections (OIs) leading to critical care needs.

  • Because of better treatment and prolonged survival, more patients are admitted to the ICU who have HIV/AIDS as an underlying illness as opposed to the cause of ICU admission.

  • Assessment of immunologic functioning via measurement of CD4+ lymphocytes is fundamental in determining risk for OIs.

  • Continuation or initiation of cART during the period of critical illness is dependent on the ability to tolerate treatment and presence or absence of certain OIs. Presence of an immune reconstitution inflammatory syndrome should often be considered.

  • Proper diagnosis of OI is important to initiate prompt targeted treatment.

  • Recognition of the social aspects of the patient’s care that lead to critical illness is important to reduce re-admissions and complications in the care of the patient.


Since the discovery of Acquired ImmunoDeficiency Syndrome (AIDS)1 and subsequently, the discovery of the causative Human Immunodeficiency Virus (HIV) in 1984,2 the understanding of the infection and its complications have led to remarkable improvements in treatment with combination antiretroviral therapy (cART), making the disease a chronic, manageable condition. However, despite the impressive advances in disease management, lack of access to care, delayed diagnosis, and incomplete adherence to cART have continued to plague many people living with HIV/AIDS (PLWHA), leading them to life-threatening complications that require prompt recognition and intensive care resources to adequately manage. While the incidence of opportunistic infections (OIs) has declined with the advance of cART, they remain important diagnoses for the critical care physician to recognize and manage. However, patients on cART can have a suppressed viral load with a lower risk for complications of AIDS but may still require intensive care management for other conditions not directly related to HIV/AIDS. Therefore, the critical care physician must also be able to differentiate patients at risk for AIDS-related complications from those who are admitted for conditions unrelated to HIV. Thus, physicians in this setting need to be aware of the basics of treating HIV as a chronic condition as well. The effectiveness of ART has improved substantially, and sustained viral suppression prevents sexual transmission of HIV.3–6 Today, persons who receive an HIV diagnosis soon after infection and who maintain viral suppression have a nearly normal life expectancy.7 However, the systemic barriers to effective health care, which include systemic racism, poverty, homelessness, discrimination, homophobia, and transphobia, but also lack of insurance, mental health, and substance abuse, impede access to testing, treatment, and prevention services and drive inequity.8 These factors are amplified in resource-poor settings with barriers to diagnostic testing, linkage to care, and access to cART that lead to increased mortality.9 While these factors do not directly impact the clinical management decisions of the critical care physician, they do inform the ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.