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Outcome and Prognostic Factors in HIV-1–Infected Patients on Dialysis in the cART Era: a GESIDA/SEN Cohort Study

Trullàs, Joan-Carles MD*; Cofan, Federico MD††; Barril, Guillermina MD; Martínez-Castelao, Alberto MD§; Jofre, Rosa MD; Rivera, Maite MD; Martínez-Ara, Jorge MD#; Ros, Silvia MD**; Perez, Iñaki MD; Moreno, Asunción MD, PhD; Miró, Jose M MD, PhDthe Spanish HIV Infection in Dialysis Study Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2011 - Volume 57 - Issue 4 - p 276-283
doi: 10.1097/QAI.0b013e318221fbda
Clinical Science

Background: Prognosis of HIV-infected patients on dialysis has improved. Few studies have compared survival between HIV-infected and HIV-negative patients on dialysis in the combined antiretroviral therapy (cART) era. We compared the outcome of HIV-infected patients on dialysis with a matched HIV-negative cohort.

Methods: National, multicenter, retrospective cohort study of HIV-infected patients starting dialysis in Spain (1999-2006). Matching criteria for HIV-negative patients were dialysis center, year of starting dialysis, age, sex, and race.

Results: The study population comprised 122 patients, 66 HIV-infected, and 66 HIV-negative patients. Median age was 41 years, and all but 4 HIV-infected patients were white. HIV-associated nephropathy was only present in 4 cases. HIV-infected patients were less frequently included on the kidney transplantation waiting list (17% vs 62%, P < 0.001). They also had more hepatitis C virus coinfection (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 rates [95% confidence interval (CI)] at 1, 3, and 5 years for HIV-infected patients were 95.2% (89.9%-100%), 71.7% (59.7%-83.7%), and 62.7% (46.6%-78.8%). Five-year survival for HIV-negative patients was 94.4% (83.8%-100%) (P < 0.001). Multivariate analysis revealed the following variables to be associated with death in HIV-infected patients: peritoneal dialysis vs hemodialysis [hazard ratio; (95% CI): 2.88 (1.16-7.17)] and being on effective cART [hazard ratio (95% CI): 0.39 (0.16-0.97)].

Conclusions: Medium-term survival of HIV-infected patients on dialysis was lower than that of matched HIV-negative patients. Fewer HIV-infected patients had access to kidney transplantation. Being on effective cART improves survival. Further studies are needed to determine whether peritoneal dialysis increases mortality.

From the *Hospital Sant Jaume de Olot University of Girona, Girona, Spain; †Infectious Diseases Service, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; ‡Hospital Universitario La Princesa, Madrid, Spain; §Hospital Bellvitge-IDIBELL, Universitari de Barcelona, Barcelona, Spain; ‖Hospital Universitario Gregorio Marañón, Madrid, Spain; ¶Hospital University Ramón y Cajal, Madrid, Spain; #Hospital Universitario La Paz, Madrid, Spain; **Hospital Universitario Carlos Haya, Málaga, Spain; and ††Renal Transplant Unit, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.

Received for publication December 27, 2010; accepted April 27, 2011.

Partially supported by grants from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica-GESIDA Foundation (FSG), the “Red Temática Cooperativa de Grupos de Investigación en Sida del Fondo de Investigación Sanitaria” from the Instituto de Salud Carlos III (RETIC RD06/006), and the Spanish Foundation for AIDS Research and Prevention (FIPSE grant 24-0858-09), Madrid, Spain. Dr. J. M. Miró holds an INT10/219 Intensification Research Grant (I3SNS & PRICS programs) from the “Instituto de Salud Carlos III, Madrid, Spain” and the “Departament de Salut de la Generalitat de Catalunya, Barcelona, Spain.”

These results were presented in part at the 17th Conference of Retroviruses and Opportunistic Infections; February, 16-19, 2010; San Francisco, CA. Abstract 739.

Disclosure Statement: All the authors have read and approved the article. They have all contributed significantly to the work. None of the article's contents have been previously published, and the article is not being considered for publication elsewhere in whole or part in any language. No authors have any conflicts of interest to disclose regarding the work presented in this article.

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Correspondence to: Jose M. Miró, MD, PhD, Infectious Diseases Service, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel, 170, Barcelona 08036 Spain (e-mail: jmmiro@ub.edu).

© 2011 Lippincott Williams & Wilkins, Inc.