PHYSICAL FUNCTION OF PATIENTS INFECTED WITH HIV REQUIRING INTENSIVE CARE UNIT STAY FOR MECHANICAL VENTILATION: A PILOT STUDY

R. Roos^1,2, H. van Aswegen^1,2, N. Thupana¹, M. McCree², M. Mer^2,3

Background: Sub-Saharan Africa remains the region most affected by HIV and is home to 53% of the world’s HIV population. The disease is a chronic disease where individuals' health status may fluctuate between periods of wellness, illness and episodic disability. People infected with HIV may be at high risk for critical illness due to severe opportunistic infections, a susceptibility to bacterial sepsis and tuberculosis (TB), and a rising prevalence of co-morbid conditions in patients aging with controlled disease. Little is known about the physical function of ICU survivors who are HIV positive in a high HIV prevalent area and secondly the challenges that one might encounter when conducting such a study.

Purpose: The purpose was to describe the physical function outcomes of ICU survivors who are HIV positive in a high HIV prevalent area and to identify challenges that may present itself when conducting such a study.  

Methods: A prospective longitudinal observational study was conducted from September 2016 – September 2018 in adult patients admitted to ICU who required mechanical ventilation (MV). Participants were assessed at ICU and ward admission, hospital discharge, three and six months following discharge. The demographic and clinical profiles of participants were collected by questionnaire. Physical function was assessed with the ICU Mobility Scale, Karnofsky Performance Status Scale, Six-Minute Walk Test, Medical Research Council-SUM Score, maximal inspiratory pressure, hand-grip strength and the EQ-5D-3L provided information on participants’ health-related quality of life (QOL). Descriptive statistics were used to analyze the data.

Results: One hundred and seventy three individuals were screened. Frequent reasons why individuals were excluded from participation were HIV status unknown (n=49), not meeting the MV requirement (n=26), TB-co-infection (n=11), patients died before a 24 hour stay in ICU (n=12) and participants declined participation (n=3). Eighteen baseline assessments were done and n=13 of these excluded due to death prior to giving study consent. A total of five participants (n=1 [male], n=4 [female]) with a median age of 40 (30-48.5) years, median APACHE II severity of illness score of 37 (20.3-41.8) and median CD₄ count of 79 (58-212.5) cells/mm³ were included. All participants were independently mobile and on antiretroviral therapy prior to hospital admission. The median ICU length of stay was 6 (5.5-20) days with MV time 108 (62.5-154) hours and hospital length of stay 37 (13-57.5) days. Respiratory and peripheral muscle weakness were present with variable performance in physical function across participants. Improvement in function occurred over time but most participants still had physical dysfunction at six months. In the two (40%) participants who survived to six months following hospital discharge, pain or discomfort were common complaints influencing their QOL.

Conclusion(s): ICU survivors, who are HIV-positive, present with significant physical dysfunction that requires rehabilitation to reduce disability. A number of challenges were identified during the course of the project that hampers the success of a longitudinal study and require consideration when constructing such a project.  

Implications: The impairments and physical function challenges identified in study participants highlight the need for continued rehabilitation services to lessen the level of their disability.  

Funding, acknowledgements: Research Foundation, South African Society of Physiotherapy.

Keywords: Human immunodeficiency virus, physical function, intensive care unit

Topic: Oncology, HIV & palliative care

Did this work require ethics approval? Yes

Institution: University of the Witwatersrand

Committee: Human Research Ethics Committee (Medical)

Ethics number: M151119