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.

中文翻译：

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在 ICU 中管理现代 ART：克服 HIV 重症患者面临的挑战

HIV 感染者 (PWH) 入住重症监护病房 (ICU) 的风险高出 50%，通常是因为非 HIV 相关疾病。尽管如此，在这种情况下仍缺乏管理抗逆转录病毒治疗（ART）的明确指导。由于药物相互作用、吸收问题和剂量调整，在 ICU 中选择合适的 ART 很复杂。由于器官功能障碍、药物相互作用和处方限制，在 ICU 中继续进行 ART 可能具有挑战性。然而，经过仔细考虑，通过剂量调整或替代给药方法继续治疗通常是可行的。根据临床情况，暂时停止 ART 可能是有益的。临床医生应积极寻求资源和支持，以减轻危重感染者的不良事件和药物相互作用。应对 ICU 的挑战可以优化 ART 并改善危重感染者的护理和结果。本综述旨在确定应对 ICU 使用现代 ART 相关挑战的策略。