HIV infection and critical illness: Pulmonary in origin

Despite the effectiveness of HAART and prophylaxis against opportunistic infections, Pneumocystis carinii pneumonia (PCP) is still the most common reason for ICU admission of HIV-infected patients. Bronchoscopy with bronchoalveolar lavage, with or without biopsy, or sputum induction with hypertonic saline is used to establish the diagnosis. The predictive value of various laboratory tests and scoring systems in determining outcomes varies for patients with PCP. The severity of the underlying HIV disorder or comorbid disease, and the experience of the hospital and caregivers appear to have the most bearing on clinical outcomes. Decisions regarding the appropriateness of critical care for patients, regardless of whether they are currently being treated with HAART, may require close collaboration with an expert in antiretroviral treatment.