Annals of Emergency Medicine
Volume 52, Issue 3 , Pages 274-285 , September 2008

Care of the HIV-Positive Patient in the Emergency Department in the Era of Highly Active Antiretroviral Therapy

  • Arvind Venkat, MD

      Affiliations

    • Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA
    • Corresponding Author InformationAddress for correspondence: Arvind Venkat, MD, Department of Emergency Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212; 412-359-6180, fax 412-359-8874
  • ,
  • David M. Piontkowsky, MD, JD

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA
  • ,
  • Robert R. Cooney, MD

      Affiliations

    • Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA
  • ,
  • Adarsh K. Srivastava, MD

      Affiliations

    • Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA
  • ,
  • Gregory A. Suares, MD

      Affiliations

    • Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA
  • ,
  • Cory P. Heidelberger, MD

      Affiliations

    • Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA

Received 4 December 2007 ,Revised 8 January 2008 ,Accepted 16 January 2008.

References 

  1. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. 2005;Presented at the National HIV Prevention Conference, Atlanta, GA.
  2. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2005. Atlanta, GA: US Department of Health and Human Services; 2007;CDC
  3. Lima V, Hogg R, Harrigan P, et al. Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS. 2007;21:685–692
  4. Palella F, Delaney K, Moorman A, et al. Declining morbidity and mortality among patients with advanced HIV infection (HIV outpatient study investigators). N Engl J Med. 1998;338:853–860
  5. Talan D, Kennedy C. The management of HIV-related illness in the emergency department. Ann Emerg Med. 1991;20:1355–1365
  6. Guss D. The acquired immune deficiency syndrome: an overview for the emergency physician, part 1. J Emerg Med. 1994;12:375–384
  7. Guss D. The acquired immune deficiency syndrome: an overview for the emergency physician, part 2. J Emerg Med. 1994;12:491–497
  8. Pulvirenti J. Inpatient care of the HIV infected patient in the highly active antiretroviral therapy (HAART) era. Curr HIV Res. 2005;3:133–145
  9. Pulivrenti J, Muppidi U, Glowacki R, et al. Changes in HIV-related hospitalizations during the HAART era in an inner city hospital. AIDS Read. 2007;17:390–394397-401.
  10. Kozak L, McCarthy E, Moien M. Patterns of hospital use by patients with diagnoses related to HIV infection. Public Health Reports. 1993;106:571–581
  11. Kozak L, DeFrances C, Hall M. National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2006;162:1–209
  12. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents (Department of Health and Human Services). http://www.aidsinfo.nih.govDecember 1 2007:1-136. Accessed December 20, 2007.
  13. Bartlett J, Gallant J. Medical Management of HIV Infection. Baltimore, MD: Johns Hopkins Medicine Health Publishing Business Group; 2007;
  14. Falco V, Rodriguez D, Ribera E, et al. Severe nucleoside-associated lactic acidosis in HIV-infected patients: a report of 12 patients and review of the literature. Clin Infect Dis. 2002;34:838–846
  15. Lalezari J, Goodrich J, DeJesus E, et al. Efficacy and safety of maraviroc plus optimized background therapy in viremic ART-experienced patients infected with CCR-5-tropic HIV-1: 24 week results of a phase 2b/3 study in the US and Canada. 2007;Presented at the 14th Conference on Retroviruses and Opportunistic Infection, Los Angeles, CA.
  16. Grinztejn B, Nguyen B, Katlama C, et al. Safety and efficacy of HIV-1 integrase inhibitor raltegravir (MK-0518) in treatment experienced patients with multi-drug resistant virus: a phase II randomized controlled trial. Lancet. 2007;369:1261–1269
  17. Shelburne S, Visnegarwala F, Darcourt J, et al. Incidence and risk factors for IRIS during HAART. AIDS. 2005;19:399–405
  18. Crum-Cianflone N. Immune reconstitution inflammatory syndromes: what's new?. AIDS Read. 2006;16:199–206
  19. Oh J, Hegele R. HIV-associated dyslipidaemia: pathogenesis and treatment. Lancet Infect Dis. 2007;7:787–796
  20. Stein J, Klein M, Bellehumeur J, et al. Use of HIV-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation. 2001;104:257–262
  21. Friis-Moller N, Sabin C, Weber R, et al. DAD Study Group Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349:1993–2003
  22. Triant V, Lee H, Hadigan C, et al. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–2512
  23. Friis-Moller N, Reiss P, Sabin C, et al. DAD Study Group Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356:1723–1735
  24. DeCastro S, Migliau G, Silvestri A, et al. Heart involvement in AIDS: a prospective study during various stages of the disease. Eur Heart J. 1992;13:1452–1459
  25. Sudano I, Spieker L, Noll G, et al. Cardiovascular disease in HIV infection. Am Heart J. 2006;151:1147–1155
  26. Fine M, Auble T, Yealy D, et al. A prediction rule to identify low risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250
  27. Wolff A, O'Donnell A. Pulmonary manifestations of HIV infection in the era of highly active antiretroviral therapy. Chest. 2001;120:1888–1893
  28. Lazarous D, O'Donnell A. Pulmonary infections in the HIV-infected patient in the era of highly active antiretroviral therapy: an update. Curr Infect Dis Rep. 2007;9:228–232
  29. Centers for Disease Control and Prevention. Treating opportunistic infections in HIV-infected adults and adolescents. MMWR Morb Mortal Wkly Rep. 2004;53:1–112
  30. Crothers K, Butt A, Gibert C, et al. Increased COPD among HIV-positive compared to HIV-negative veterans. Chest. 2006;130:1326–1333
  31. Crothers K. Chronic obstructive pulmonary disease in patients who have HIV infection. Clin Chest Med. 2007;28:575–587
  32. Limsukon A, Saeed A, Ramaswamy V, et al. HIV-related pulmonary hypertension. Mt Sinai J Med. 2006;73:1037–1044
  33. Wyatt C, Klotman P. HIV-associated nephropathy in the era of antiretroviral therapy. Am J Med. 2007;120:488–492
  34. Franceschini N, Napravnik S, Eron J, et al. Incidence and etiology of acute renal failure among ambulatory HIV-infected patients. Kidney Int. 2005;67:1526–1531
  35. Quimby D, Brito M. Fanconi syndrome associated with use of tenofovir in HIV-infected patients: a case report and review of the literature. AIDS Read. 2005;15:357–364
  36. de Silva T, Post F, Griffin M, et al. HIV-1 infection and the kidney: an evolving challenge in HIV medicine. Mayo Clin Proc. 2007;82:1103–1116
  37. Wyatt C, Arons R, Klotman P, et al. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS. 2006;20:561–565
  38. Heyns C, Fisher M. The urological management of the patient with acquired immunodeficiency syndrome. BJU Int. 2005;95:709–716
  39. Couzigou C, Daudon M, Meynard J, et al. Urolithiasis in HIV-positive patients treated with atazanavir. Clin Infect Dis. 2007;45:e105–e108
  40. Manzardo C, Del Mar Ortega M, Sued O, et al. Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era. J Neurovirol. 2005;11(suppl 3):72–82
  41. Rothman R, Keyl P, McArthur J, et al. A decision guideline for ED utilization of noncontrast head CT in HIV-infected patients. Acad Emerg Med. 1999;6:1010–1019
  42. d'Arminio Monforte A, Sabin C, Phillips A, et al. The changing incidence of AIDS events in patients receiving HAART. Arch Intern Med. 2005;165:416–423
  43. Eng P, Turnbull B, Cook S, et al. Characteristics and antecedents of progressive multifocal leukoencephalopathy in an insured population. Neurology. 2006;67:884–886
  44. Bossolasco S, Calori G, Moretti F, et al. Prognostic significance of JC virus DNA levels in CSF of patients with HIV-associated PML. Clin Infect Dis. 2005;40:738–744
  45. Martinez J, Mazziotti J, Efron E, et al. Immune reconstitution inflammatory syndrome associated with PML in AIDS: a treatable disorder. Neurology. 2006;67:1692–1694
  46. Du Pasquier R, Koralnik I. Inflammatory reaction in PML: harmful or beneficial?. J Neurovirol. 2003;9(suppl 1):25–31
  47. Kadan-Lottick N, Skluzacek M, Gurney J. Decreasing incidence rates of primary CNS lymphoma. Cancer. 2002;95:193–202
  48. Jones J, Hanson D, Dworkin M, et al. Effect of antiretroviral therapy on recent trends in selected cancers among HIV-infected persons. J Acquir Immune Defic Syndr. 1999;21(suppl 1):S11–S17
  49. Gerstner E, Batchelor T. Primary CNS lymphoma. Expert Rev Anticancer Ther. 2007;7:689–700
  50. Rabinstein A. Stroke in HIV-infected patients: a clinical perspective. Cerebrovasc Dis. 2003;15:37–44
  51. Cole J, Pinto A, Hebel J, et al. Acquired immunodeficiency syndrome and the risk of stroke. Stroke. 2004;35:51–56
  52. Ryan C. New black box warning for ritonavir-boosted tipranavir. AIDS Clin Care. 2006;18:72
  53. Ferrari S, Vento S, Monaco S, et al. HIV-associated peripheral neuropathies. Mayo Clin Proc. 2006;81:213–219
  54. Schifitto G, McDermott M, McArthur J, et al. Incidence of and risk factors for HIV-associated distal sensory neuropathy. Neurology. 2002;58:1764–1768
  55. Hahn K, Arendt G, Braun J, et al. A placebo-controlled trial of gabapentin for HIV-associated sensory neuropathies. J Neurol. 2004;251:1260–1266
  56. HIV Neuromuscular Syndrome Study Group. HIV-associated neuromuscular weakness syndrome. AIDS. 2004;18:1403–1412
  57. Mocroft A, Oancea C, van Lunzen J, et al. Decline in esophageal candidiasis and use of antimycotics in European patients with HIV. Am J Gastroenterol. 2005;100:1446–1454
  58. Pulvirenti J, Mehra T, Hafiz I, et al. Epidemiology and outcome of Clostridium difficile infection and diarrhea in HIV infected inpatients. Diagn Microbiol Infect Dis. 2002;44:325–330
  59. Sanchez T, Brooks J, Sullivan P, et al. Bacterial diarrhea in persons with HIV infection, United States, 1999-2002. Clin Infect Dis. 2005;41:1621–1627
  60. Nunez M, Puoti M, Camino N, et al. Treatment of chronic hepatitis B in the human immunodeficiency virus infected patient: present and future. Clin Infect Dis. 2003;37:1678–1685
  61. Monga H, Rodriguez-Barradas M, Breaux K, et al. Hepatitis C virus infection-related morbidity and mortality among patients with human immunodeficiency virus infection. Clin Infect Dis. 2001;33:240–247
  62. De Luca A, Bugarini R, Lepri A, et al. Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected patients. Arch Intern Med. 2002;162:2125–2132
  63. den Brinker M, Wit F, Wertheim-van Dillen P, et al. Hepatitis B and C virus co-infection and the risk of hepatotoxicity highly active anti-retroviral therapy in HIV-1 infection. AIDS. 2000;14:2895–2902
  64. Kottilil S, Polis M, Kovacs J. HIV infection, hepatitis C infection, and HAART: hard clinical choices. JAMA. 2004;292:243–250
  65. Sullivan P, Hanson D, Chu S, et al. Epidemiology of anemia in HIV-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood. 1998;91:301–308
  66. Volberding P, Levine A, Dietrich D, et al. Anemia in HIV infection: clinical impact and evidence-based management strategies. Clin Infect Dis. 2004;38:1454–1463
  67. Bani-Sadr F, Goderel I, Penalba C, et al. Risk factors for anemia in HIV /hepatitis C virus-coinfected patients treated with interferon plus ribavirin. J Viral Hepat. 2007;14:639–644
  68. Huang S, Barbour J, Deeks S. Reversal of HIV type-1 associated hematosuppression by effective antiretroviral therapy. Clin Infect Dis. 2000;30:504–510
  69. Klein S, Slim E, de Kruif M, et al. Is chronic HIV infection associate with venous thrombotic disease? (A systematic review). Neth J Med. 2005;63:129–136
  70. Sutor G, Schmidt R, Albrecht H. Thrombotic microangiopathies and HIV infection: report of two typical cases, features of HUS and TTP, and review of the literature. Infection. 1999;27:12–15
  71. Biggar R, Jaffe E, Goedert J, et al. Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS. Blood. 2006;108:3786–3791
  72. Silverberg M, Abrams D. AIDS-defining and non-AIDS defining malignancies: cancer occurrence in the antiretroviral therapy era. Curr Opin Oncol. 2007;19:446–451
  73. Brown T, Cole S, Li X, et al. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med. 2005;165:1179–1184
  74. Bhasin S, Cunningham G, Hayes F, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995–2010
  75. Wunder D, Bersinger N, Fux C, et al. Hypogonadism in HIV-1 infected men is common and does not resolve during antiretroviral therapy. Antivir Ther. 2007;12:261–265
  76. Crum N, Furtek K, Olsen P, et al. A review of hypogonadism and erectile dysfunction among HIV-infected men during the pre- and post-HAART eras: diagnosis, pathogenesis, and management. AIDS Patient Care STDs. 2005;19:655–671
  77. Hoffmann C, Brown T. Thyroid function abnormalities in HIV-infected patients. Clin Infect Dis. 2007;45:488–494
  78. Angelino A, Treisman G. Management of psychiatric disorders in patients infected with HIV. Clin Infect Dis. 2001;33:847–856
  79. Ellen S, Judd F, Mijch A, et al. Secondary mania in patients with HIV infection. Aust N Z J Psychiatry. 1999;33:353–360
  80. Arendt G, de Nocker D, von Giesen H, et al. Neuropsychiatric side effects of efavirenz therapy. Expert Opin Drug Saf. 2007;6:147–154
  81. Reveille J. The changing spectrum of rheumatic disease in human immunodeficiency virus infection. Semin Arthritis Rheum. 2000;30:147–166
  82. Marquez J, Restrepo C, Candia L, et al. Human immunodeficiency virus-associated rheumatic disorders in the HAART era. J Rheumatol. 2004;31:741–746
  83. Schwartzman W, Lambertus M, Kennedy C, et al. Staphylococcal pyomyositis in patients infected by the human immunodeficiency virus. Am J Med. 1991;90:595–600
  84. Crum N. Bacterial pyomyositis in the United States. Am J Med. 2004;117:420–428
  85. Calabrese L, Kirchner E, Shrestha R. Rheumatologic complications of HIV infection in the era of HAART. Semin Arthritis Rheum. 2005;35:166–174
  86. Glesby M. Bone disorders in HIV infection. Clin Infect Dis. 2003;37(suppl 2):S91–S95
  87. Prior J, Burdge D, Maan E, et al. Fragility fractures and bone mineral density in HIV positive women: a case-control population based study. Osteoporos Int. 2007;18:1345–1353
  88. Arnsten J, Freeman R, Howard A, et al. Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection. AIDS. 2007;21:617–623
  89. Williams D, Feely J. Pharmacokinetic-pharmacodynamic drug interactions with HMG-CoA reductase inhibitors. Clin Pharmacokinet. 2002;41:343–370
  90. Martins C. Cutaneous drug reactions associated with newer antiretroviral agents. J Drugs Dermatol. 2006;5:976–982
  91. Maurer T, Rodrigues L, Ameli N, et al. The effect of HAART on dermatologic disease in a longitudinal study of HIV-type 1 infected women. Clin Infect Dis. 2004;38:579–584
  92. Zancanaro P, McGirt L, Mamelak A, et al. Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: an institutional urban clinic experience. J Am Acad Dermatol. 2006;54:581–588
  93. Martin A, Nolan D, Gaudieri S, et al. Predisposition to abacavir hypersensitivity conferred by HLA B*5701 and a haplotypic Hsp70-Hom variant. Proc Natl Acad Sci U S A. 2004;101:4180–4185
  94. Hewitt R. Abacavir hypersensitivity reaction. Clin Infect Dis. 2002;34:1137–1142
  95. Hodgson T, Greenspan D, Greenspan J. Oral lesions of HIV and HAART in industrialized countries. Adv Dent Res. 2006;19:57–62
  96. Jacobson M, Stanley H, Holtzer C, et al. Natural history and outcome of new AIDS-related cytomegalovirus retinitis diagnosed in the era of HAART. Clin Infect Dis. 2000;30:231–233
  97. Karavellas M, Azen S, MacDonald J, et al. Immune recovery vitritis and uveitis in AIDS: clinical predictors, sequelae, and treatment outcomes. Retina. 2001;21:1–9

 Supervising editor: David A. Talan, MD

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Piontkowsky is leaving the employ of Allegheny General Hospital and has accepted a position with Pfizer Pharmaceuticals.

 Earn CME Credit: Continuing Medical Education is available for this article at www.ACEP-EMedhome.com.

 Publication dates: Available online March 21, 2008.

 Reprints not available from authors.

PII: S0196-0644(08)00356-9

doi: 10.1016/j.annemergmed.2008.01.324

Annals of Emergency Medicine
Volume 52, Issue 3 , Pages 274-285 , September 2008