TABLE 2.

EXAMPLES OF FUTURE AREAS OF RESEARCH FOR CRITICALLY ILL HIV-INFECTED PATIENTS

Predisposing risk factors for ICU admission

• How does ART use affect risk for ICU admission due to comorbid medical disease?

• How do health insurance status and health-care use affect risk for ICU admission?

Use and delivery of ICU care

• Are there disparities in ICU admission patterns and delivery of ICU interventions for critically ill HIV-infected patients compared with HIV-uninfected patients?

• Do clinical tools that assess severity of illness for HIV-infected patients, incorporating AIDS-related disease and measures of multimorbidity, identify HIV-infected patients at greatest risk of ICU-related morbidity and mortality?

• Are medical provider attitudes toward care of critically ill HIV-infected patients different from attitudes toward non–HIV-infected patients?

• How and when should palliative care for critically ill HIV-infected patients be provided? (This may be particularly challenging with regard to how ART may affect long-term survival in ART-naive patients.)

ART in the ICU

• When should ART be initiated in the ICU? Should this be based on stability of presenting critical illness or failure of response to initial treatment of presenting critical illness?

• Are there specific AIDS-related diseases where ART initiation in the ICU is warranted (i.e., ART use in refractory respiratory failure from PCP)?

• When is it safe to continue ART in the ICU? Which regimens of ART are safe to use with specific organ failure (acute kidney injury vs. decompensated cirrhosis)?

• What are the risk factors for development of IRIS in critically ill HIV-infected patients?

Outcomes after ICU admission

• How do long-term outcomes differ by ICU admission diagnosis (i.e., AIDS-related disease vs. decompensated comorbid disease)?

• Are there outcome differences between patients who do and do not receive ART in the ICU?

• Is there a difference in 90-d or 1-yr mortality between patients who initiate ART in the ICU compared with those who do not?

• Is there a difference in mortality between patients who continue ART in the ICU compared with those who do not?

• What are the functional status, exercise capacity, cognitive function, and health-related quality of life in HIV-infected survivors of critical illness, and how do these vary by indications for ICU admission, ART use, and delivery of ICU care?

• Do outcomes after critical illness differ in older vs. younger HIV-infected patients?

Definition of abbreviations: ART = antiretroviral therapy; ICU = intensive care unit; IRIS = immune reconstitution inflammatory syndrome; PCP = Pneumocystis jirovecii pneumonia.