TY - CHAP M1 - Book, Section TI - Human Immunodeficiency Virus (HIV) and AIDS in the Intensive Care Unit A1 - Hull, Mark A1 - Linder, Adam M. A1 - Montaner, JSG A1 - Russell, James A. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - The acquired immunodeficiency syndrome (AIDS) is caused by chronic infection with the human immunodeficiency virus (HIV), which through its relentless replication causes progressive depletion of T-helper lymphocytes leading to severe cellular immunodeficiency.In the absence of treatment, after a variable period, usually years from infection, multiple opportunistic infections or neoplasms characteristic of AIDS develop.Combination antiretroviral therapy has been shown to prolong survival as well as disease-free interval. Furthermore, antiretroviral therapy has emerged as an effective primary prevention. Despite substantial progress in antiretroviral therapy, cure of the disease remains elusive.Acute respiratory failure (ARF) secondary to Pneumocystis jirovecii pneumonia (PJP) is now less common than during the early years of HIV/AIDS as a cause of ICU admission among HIV-infected individuals with advanced HIV infection.PJP usually is diagnosed in the ICU using bronchoalveolar lavage (BAL). BAL fluid should always be processed to allow identification of P jirovecii, fungi, common bacteria, mycobacteria, and viruses.The mortality of PJP-related ARF has decreased substantially with the use of adjunctive systemic corticosteroids. Patients developing ARF despite corticosteroid treatment, however, continue to have a dismal prognosis.Because of better treatment and prolonged survival, more patients are admitted to ICU who have HIV/AIDS as an underlying illness as opposed to the cause of ICU admission.HIV cannot be transmitted through casual contact. Universal precautions, however, must be implemented and enforced routinely to minimize the risk of occupational exposure to HIV (as well as other infectious agents). The rate of seroconversion following a single accidental needle stick or mucous membrane exposure appears to be well below 1%.The issue of life support should be discussed early and reassessed frequently with HIV-infected individuals. Because the outlook of AIDS and its related diseases has improved dramatically, rigid policies regarding ICU admission are not appropriate. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1107720680 ER -