ABSTRACT
The initiation of anti-retrovirals in critically ill patients is complicated. Although there are no prospective trials that address this issue; retrospective studies suggest that early initiation of treatment in these patients is probably beneficial. Hesitance to use these drugs in an intensive care population stems from problems related to anti-retroviral administration; toxicities; drug interactions; altered pharmacokinetics of the drugs and the immune reconstitution inflammatory syndrome (IRIS). In addition to this; critically ill patients are often unable to give informed consent for HIV testing; or undergo appropriate counseling; which raises ethical problems; as well as problems related to long-term compliance. This article summarizes the evidence available for the early initiation of anti-retrovirals in critically ill patients; as well as problems related to their administration