Managing modern ART in the ICU: overcoming challenges for critically ill people with HIV

Abstract People with HIV (PWH) have a 50% excess risk for intensive care unit (ICU) admission, often for non-HIV-related conditions. Despite this, clear guidance for managing antiretroviral therapy (ART) in this setting is lacking. Selecting appropriate ART in the ICU is complex due to drug interactions, absorption issues, and dosing adjustments. Continuing ART in the ICU can be challenging due to organ dysfunction, drug interactions, and formulary limitations. However, with careful consideration, continuation is often feasible through dose adjustments or alternative administration methods. Temporary discontinuation of ART may be beneficial depending on the clinical scenario. Clinicians should actively seek resources and support to mitigate adverse events and drug interactions in critically ill PWH. Navigating challenges in the ICU can optimize ART and improve care and outcomes for critically ill PWH. This review aims to identify strategies for addressing the challenges associated with the use of modern ART in the ICU.