DOES HIV STATUS INFLUENCE THE OUTCOME OF PATIENTS ADMITTED TO A SURGICAL INTENSIVE-CARE UNIT - A PROSPECTIVE DOUBLE-BLIND-STUDY

Objectives: (a) To assess the impact of HIV status (HIV negative, HIV positive, AIDS) on the outcome of patients admitted to intensive care units for diseases unrelated to HIV; (b) to decide whether a positive test result for HIV should be a criterion for excluding patients from intensive care for diseases unrelated to HIV. Design: A prospective do uble blind study of all admissions over six months. HIV status was det ermined in all patients by enzyme linked immunosorbent assay (ELISA), immunofluorescence assay, western blotting, and now cytometry. The eth ics committee considered the clinical implications of the study import ant enough to waive patients' right to informed consent Staff and pati ents were blinded to HIV results. On discharge patients could be advis ed of their HIV status if they wished. Setting: A 16 bed surgical inte nsive care unit. Subjects: All 267 men and 135 women admitted to the u nit during the study period. Interventions: None. Main outcome measure s: APACHE II score (acute physiological, age, and chronic health evalu ation), organ failure, septic shock, durations of intensive care unit and hospital stay, and intensive care unit and hospital mortality. Res ults: No patient had AIDS. 52 patients were tested positive for HIV an d 350 patients were tested negative. The two groups were similar in se x distribution but differed significantly in age, incidence of organ f ailure (37 (71%) v 171 (49%) patients), and incidence of septic shock (20 (38%) v 54 (15%)). After adjustment for age there were no differen ces in intensive care unit or hospital mortality or in the durations o f stay in die intensive care unit or hospital. Conclusions: Morbidity was higher in HIV positive patients but there was no difference in mor tality. In this patient population a positive HIV test result should n ot be a criterion for excluding a patient from intensive care.