While you should always involve ID consultants when managing critically-ill HIV/AIDS patients on HAART, consider this; sub-therapeutic levels of anti-retrovirals may promote HIV resistance, potentially invalidating a class of drug for future use. Therefore, it may be advantageous to discontinue the drug(s) during critical-illness to avoid resistance.
Two examples leading to sub-therapeutic HAART levels in critical-illness:
Reduced absorption of PO medications from bowel wall edema and/or decreased splanchnic perfusion.
Interactions with HAART medications and the multitude of other drugs administered in the ICU.
References
Current issues in critical care of the human immunodeficiency virus-infected patient. Morris A, Masur H, Huang L Crit Care Med. 2006 Jan;34(1):42-9.
