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People living with HIV, HCV and HIV/HCV coinfection in intensive care in a German tertiary referral center 2014–2019

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Abstract

Purpose

The epidemiology of HIV-infected individuals on the Medical Intensive Care Units (MICU) has changed after profound progress in treatment of AIDS-defining illnesses and anti-retroviral therapy (ART). Changes of MICU utilization of Hepatitis C (HCV) patients following roll-out of direct-acting antivirals (DAA) are yet to evaluate.

Methods

We performed a retrospective study on all patients with HIV, HIV/HCV and HCV admitted to the MICU of University Hospital Bonn 2014–2019. We assessed sociodemographic data, available clinical data from HIV patients (CDC stage, CD4 + lymphocyte cell count, HIV-1-RNA, ART) and HCV patients (HCV-RNA, stage of liver cirrhosis, treatment history) and outcome.

Results

237 patients (46 HIV, 22 HIV/HCV, 169 HCV; 168 male, median age 51.3 years) with 325 MICU admissions were included. Admission criteria for HIV patients were infections (39.7% AIDS-associated, 23.8% with controlled HIV-infection) and cardiopulmonary diseases (14.3%). HIV/HCV coinfected patients had infections in controlled/uncontrolled HIV-infection (46.4%), cardiopulmonary diseases and intoxication/drug abuse (17.9% each). Reasons for HCV-mono-infected patients were infections (24.4%), sequelae of liver disease (20.9%), intoxication/drug abuse (18.4%) and cardiopulmonary diseases (15%). 60 patients deceased; most important risk factor was need for mechanical ventilation. The number of HCV-patients admitted to MICU with chronic active disease and sequelae of liver disease decreased while the proportion of patients with completed DAA-treatment increased.

Conclusion

Infections remain the most important reason for MICU admission in patients with HIV and/or HCV infection while non-AIDS related conditions increased. DAA roll-out has a beneficial effect on liver-associated morbidity in HCV patients admitted to MICU.

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Data availability

Data available on request from the authors.

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Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

    Stefan Schlabe, Christoph Boesecke, Kathrin van Bremen, Carolynne Schwarze-Zander, Jenny Bischoff, Ulrich Spengler, Jacob Nattermann, Jürgen K. Rockstroh & Jan-Christian Wasmuth

  2. German Centre of Infection Research, Partner-Site Cologne-Bonn, Bonn, Germany

    Stefan Schlabe, Christoph Boesecke, Kathrin van Bremen, Carolynne Schwarze-Zander, Jenny Bischoff, Ulrich Spengler, Jacob Nattermann, Jürgen K. Rockstroh & Jan-Christian Wasmuth

  3. Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany

    Aylin Yürüktümen

  4. Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany

    Mario Heine

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Contributions

SS designed the study together with CB and JCW. SS wrote the main manuscript. JB, KvB, CSZ contributed data and medical information. SS, CB, JB, JN and JCW took care for the patients on Medical ICU and added details on the treatment on ICU. AY contributed details on patients in cardiological care and MH details on patients in hematological and oncological care. US and JKR revised large parts of the manuscript and strengthened the focus of the study and the manuscript. All authors read and approved the final manuscript and made substantive intellectual contributions to the work.

Corresponding author

Correspondence to Stefan Schlabe.

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Conflict of interest

C.B. reported Honoraria for lectures and/or consultancies from AbbVie, Gilead, Janssen, MSD, ViiV. Funding from Dt. Leberstiftung, DZIF, Hector Stiftung, NEAT ID. J.R. received honoraria for consulting or speaking at educational events. Gilead, Janssen, Merck, Theratechnologies and ViiV. K.v.B. received honoraria for educational events from Gilead and Abbvie. J.B. a stipend from the German Centre for Infection Research. S.S. received support for congress and travel expenses from Gilead, J&J, ViiV and Abbvie and a stipend from the German Centre for Infection Research not related to the topic of the manuscript. All other authors do not declare conflicts of interest.

Ethical approval

This single centre, retrospective study was performed according the legal and ethical requirements of the European, national and federal laws involving cohort studies in the own departments with respect to data protection and ethics. Ethical approval was waived by the local Ethics Committee of University Bonn in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. No funding was granted for this study.

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Schlabe, S., Boesecke, C., van Bremen, K. et al. People living with HIV, HCV and HIV/HCV coinfection in intensive care in a German tertiary referral center 2014–2019. Infection 51, 1645–1656 (2023). https://doi.org/10.1007/s15010-023-02032-9

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