Paper # 739 
Outcome and Prognostic Factors in HIV-1-infected Dialysis Patients in Spain in the HAART Era: A Case-Control GESIDA/SEN Study
Joan Trullas*1, G Barril2, F Cofan3, A Martínez-Castelao4, R Jofre5, M Rivera6, J Martinez-Ara7, S Ros8, A Moreno3, J Miro3, and Spanish HIV Infection in Dialysis Study Group
1Hosp Sant Jaume, Univ Girona, Spain; 2Hosp Univ La Princesa, Madrid, Spain; 3Hosp Clin, Univ of Barcelona, Spain; 4Hosp Bellvitge, Univ of Barcelona, Spain; 5Hosp Univ Gregorio Marañon, Madrid, Spain; 6Hosp Univ Ramon y Cajal, Madrid, Spain; 7Hosp Univ La Paz, Madrid, Spain; and 8Hosp Univ Carlos Haya, Malaga, Spain
Background: The
prognosis of HIV-infected patients on dialysis has improved with HAART, but few
studies have compared survival between HIV-positive and HIV-negative patients
on dialysis in the HAART era. The objectives of this study were as follows: 1)
to know the outcome of HIV-infected patients on dialysis and to compare it with
that of HIV-negative patients on dialysis; and 2) to determine prognostic
factors of mortality in the HIV-infected population.
Methods: A
national, multicentre retrospective cohort study was performed. All
HIV-infected patients with end-stage renal disease who started dialysis between
1999 and 2006 were included. HIV-infected patients were matched with
HIV-negative patients (1:1 ratio) using the following criteria: same dialysis centre, year of
starting dialysis (± 3 years), age (± 5 years), gender, and race.
Results: Sixty-six
HIV-infected patients and 66 controls on dialysis were included. Median (IQR)
age on starting dialysis was 41 (9.9) years, 76.5% were males, all but 4 HIV-infected
patients were white (P =0.04), 14% had diabetes mellitus, and 37%
were on peritoneal dialysis. Former drug abuse was the most common HIV-risk
factor, and HIV-associated nephropathy was present in 4 cases. Median (IQR)
follow-up for cases and controls was 2.63 (1.84) and 3.13 (2.87) years,
respectively. HIV-infected patients had less access to the kidney
transplantation waiting list (17% vs 62%, P <0.001), more HCV co-infection
(76% vs 11%, P <0.001), fewer cardiovascular events (62% vs 88%,
P =0.001), fewer kidney transplants (4.5% vs 38%, P <0.001),
and higher mortality (32% vs 1.5%, P <0.001). Survival (95% CI)
rates at 1, 3, and 5 years for HIV-infected patients were 95.2% (89.9 to 100%),
71.7% (59.7% to 83.7%), and 62.7% (46.6% to 78.8%), respectively. Survival for
HIV-negative patients at 5 years was 94.4% (83.8% to 100%) (P <0.001).
Among HIV-infected patients, the following variables were associated with
death: peritoneal dialysis vs hemodialysis (HR = 2.91; 95%CI 1.17 to 7.20) and
being on effective HAART (HR = 0.34; 95%CI 0.12 to 0.93), defined as having an
undetectable plasma viral load on HAART.
Discussion: Mid-term
(5 years) survival of HIV-infected patients on dialysis was lower than that of
HIV-negative patients on dialysis. Access to kidney transplantation was lower
in HIV-infected patients. Prognosis could improve by taking effective HAART.
Further studies are necessary to confirm whether peritoneal dialysis is a risk
factor for HIV-infected patients.
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