Antiretroviral Therapy Management in Adults With HIV During ICU Admission

J Pharm Pract. 2022 Dec;35(6):952-962. doi: 10.1177/08971900211000692. Epub 2021 Apr 16.

Abstract

The extended lifespan of people living with human immunodeficiency (HIV) and acquired immune deficiency syndrome (AIDS) (PLWHA) has increased the potential for ICU admissions unrelated to HIV infection. The objective of this review is to guide continued management of antiretroviral therapy (ART) recommended by the United States Department of Health and Human Services Antiretroviral Guidelines in critically ill adult PLWHA admitted to the intensive care unit (ICU). Pharmacists are uniquely positioned to mitigate these concerns, including whether to continue ART in the ICU, drug interactions with common ICU drugs, renal and hepatic dosing considerations, and alternative methods of administration. Despite these concerns, the original ART regimen should be continued or modified in conjunction with an HIV specialist. Discontinuation greater than 2 weeks should be avoided due to potential resistance and future HIV treatment failure. Use of ART in critically ill patients presents challenges that pharmacists are best equipped to address to prevent adverse events, administration errors, and treatment failure.

Keywords: HIV disease; acquired immunodeficiency; antiretroviral agents; critical care; human immunodeficiency virus; intensive care unit; medication safety; syndrome.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-HIV Agents*
  • Anti-Retroviral Agents / therapeutic use
  • Critical Illness / therapy
  • HIV Infections* / drug therapy
  • Humans
  • Intensive Care Units

Substances

  • Anti-HIV Agents
  • Anti-Retroviral Agents