Clinical evolution of chronic renal patients with HIV infection in replacement therapy

• Published in: Nefrología Vol. 35; no. 5; pp. 457 - 464
• Main Authors: Saracho, Ramón, Martín Escobar, Eduardo, Comas Farnés, Jordi, Arcos, Emma, Mazuecos Blanca, Auxiliadora, Gentil Govantes, Miguel Ángel, Castro de la Nuez, Pablo, Zurriaga, Óscar, Ferrer Alamar, Manuel, Bouzas Caamaño, Encarnación, García Falcón, Teresa, Portolés Pérez, José, Herrero Calvo, José A., Chamorro Jambrina, Carlos, Moina Eguren, Íñigo, Rodrigo de Tomás, María Teresa, Abad Díez, José María, Sánchez Miret, José I., Alvarez Lipe, Rafael, Díaz Tejeiro, Rafael, Moreno Alía, Inmaculada, Torres Guinea, Marta, Huarte Loza, Enma, Artamendi Larrañaga, Marta, Fernández Renedo, Carlos, González Fernández, Raquel, Sánchez Álvarez, Emilio, Alonso de la Torre, Ramón
• Format: Journal Article
• Language: English
• Published: Elsevier 01.09.2015
• Subjects: Chronic kidney disease renal replacement therapy; Dialysis and transplant registries; Epidemiology; HIV infection; Survival
• ISSN: 2013-2514
• DOI: 10.1016/j.nefroe.2015.11.004

Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004 to 2011 (period of use of highly active antiretroviral therapy [HAART]) in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1000 patients on RRT (95% confidence interval [CI] 4.4–5.8). Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95%CI 1.74–2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95%CI 1.10–2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95%CI: 0.10–0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.