HIV + Critical Illness: a primer of ICU management

Managing HIV-positive patients in the ICU requires distinguishing between two distinct groups: individuals unaware of their status presenting with traditional opportunistic infections and those in established care suffering from chronic, non-HIV-related conditions like cardiovascular or renal disease. CD4 counts remain a critical, reliable indicator of susceptibility to specific infections, such as *Pneumocystis* pneumonia and cryptococcal meningitis. Effective ICU care necessitates immediate infectious disease consultation to navigate the complexities of antiretroviral therapy, including potential drug interactions, absorption challenges, and the risk of developing resistance. Clinicians must also remain vigilant for Immune Reconstitution Inflammatory Syndrome (IRIS), which can mimic or exacerbate respiratory and neurological failures. While the incidence of classic AIDS-defining illnesses has declined, the shift toward managing long-term, age-related comorbidities in HIV-positive patients represents the evolving challenge for modern critical care medicine.