LAUSR

Critical Care Medicine www.ccmjournal.org 663 In the 1980s and 1990s, HIV infection inevitably (with a few rare exceptions) led to multiple opportunistic complications and premature death. Pneumocystis pneumonia, toxoplasma encephalitis, cryptococcal meningitis, cytomegalovirus retinitis, pneumococcal bacteremia, Kaposi sarcoma, and lymphoma were recurrent complications that led most patients to die within a decade of their initial AIDS diagnosis. These opportunistic processes still occur in persons who are not aware of their HIV infection or persons who are not taking antiretroviral therapy (ART) due to social, economic, or mental health challenges. In this current decade, the prospects for persons with HIV infection are much more sanguine. About half of the 1.1 million persons living in the United States have achieved the effective, long-term HIV suppression that correlates with prolonged survival (1–3). The number of persons living with HIV in the United States is not likely to fall in the next decade; since in 2014, there were 37,600 new cases of HIV infection and 6,721 deaths, a net gain of over 30,000 prevalent cases. Furthermore, the life expectancy of persons with HIV infection who are successfully treated with ART is projected to exceed 70 years suggesting that such HIV-infected persons will have almost normal life expectancies, although that life expectancy may be affected by specific HIV-related morbidities (2). With at least 600,000 persons with HIV on effective longterm ART in the United States (3), intensivists can expect to see HIV-infected patients in their ICUs for trauma, postoperative care, routine medical maladies, and the expected consequences of aging. HIV-infected persons on effective ART may in fact be overrepresented in ICUs because they have more than the expected morbidities due to their “accelerated aging,” which is a consequence of low-level chronic HIV viremias (despite ART) that produces an ongoing state of enhanced inflammation. This enhanced inflammation accelerates their development of cardiovascular, cerebrovascular, hepatic, renal and malignant neoplastic diseases (4).