ICU Admissions Rising for HIV Patients

But the news isn't necessarily bad, experts say

WEDNESDAY, May 12, 2004 (HealthDayNews) -- While fewer AIDS patients are dying in the United States than a decade ago, a new study suggests they're showing up far more often in intensive care units.

But the findings, researchers say, may actually be a sign of good news.

"We've seen more people admitted to the ICU for things not due to their HIV," said Dr. Mark J. Rosen, chief of the division of pulmonary and critical care medicine at Beth Israel Medical Center in New York City and co-author of the study.

The ailments, he added, may simply be a sign that patients are growing old enough to develop ordinary medical problems.

In the 1980s and early 1990s, AIDS patients frequently showed up in ICUs, which are designed to closely monitor patients who are at high risk of death and complications. But only an estimated 5 per cent to 10 percent of AIDS patients died in ICUs, Rosen said, possibly because their families knew they were dying and declined the extra level of care.

In the late 1990s, new drugs revolutionized the treatment of the disease, allowing doctors to greatly reduce the level of the AIDS virus in patients. AIDS is still a killer in the Western world, but many patients are doing so well on the drugs that they show no sign of illness.

The researchers examined ICU admissions at Beth Israel from 1991-1992 and in 2001. They report their findings in the May issue of Chest, the journal of the American College of Chest Physicians.

The number of ICU admissions for HIV-positive patients grew by almost 50 percent over the 10-year period. Those admitted in 2001 were more likely to be heterosexual, black, and intravenous drug users.

The findings suggest that the diagnosis of HIV should not be a strike against treatment in an ICU, Rosen said. "I would hope most doctors have that message, but there are areas that have not seen [much] HIV and AIDS and may not be aware of this," he added.

As they keep an eye on AIDS patients, hospitals must monitor what happens to them as they age, said Michael Allerton, HIV operations policy leader with the Kaiser Permanente health plan in Northern California.

AIDS drugs appear to contribute to higher cholesterol levels among the patients, and some experts fear they'll suffer from increased heart attacks as they grow older.

Even so, "HIV patients are much better off today than they were before. It's clear that HIV medications are giving a greater benefit than the risks pose," Allerton said.

Indeed, 72 percent of 5,000 HIV-positive patients in Kaiser Permanente's Northern California region show no sign of the AIDS virus in their blood, Allerton said.

Since the virus can hide in other parts of the body, that doesn't mean it's gone. But it does mean it's on the run.

More information

To learn more about HIV/AIDS and treatments, visit the Centers for Disease Control and Prevention or the National Institute of Allergy and Infectious Diseases.

SOURCES: Mark J. Rosen, M.D., chief, Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York City; Michael Allerton, M.S., HIV operations policy leader, Kaiser Permanente Northern California, Oakland, Calif. May 2004 Chest
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