oa Southern African Journal of Epidemiology and Infection - The initiation of antiretrovirals in critically ill patients : review
The use of antiretrovirals (ARVs) in critically ill patients is complicated. Although there are no prospective trials that address timing of initiation of these drugs in ICU, retrospective studies and prospective studies in more stable patients suggest that early initiation of treatment in these patients is probably beneficial. However, use of these drugs in an intensive care population has problems related to ARV administration, toxicities, drug interactions, altered pharmacokinetics of the drugs and the immune reconstitution inflammatory syndrome, and initiation should be carefully weighed in each case. In addition to this, critically ill patients are often unable to give informed consent for HIV testing, or undergo appropriate counseling, which raises ethical issues, as well as problems related to post-ICU compliance with medications. This article summarises the evidence available for the use of ARVs in critically ill patients.
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