Vascular access outcomes in HIV-positive patients

• Published in: The journal of vascular access Vol. 13; no. 4; p. 459
• Main Authors: Mistry, Hiren, Lifford, Rhiannon, Stephenson, Matthew A, Valenti, Domenico
• Format: Journal Article
• Language: English
• Published: United States 01.10.2012
• Subjects: Adult; AIDS-Associated Nephropathy - diagnosis; AIDS-Associated Nephropathy - etiology; AIDS-Associated Nephropathy - physiopathology; AIDS-Associated Nephropathy - therapy; Aneurysm - etiology; Aneurysm - physiopathology; Aneurysm, False - etiology; Aneurysm, False - physiopathology; Arteriovenous Shunt, Surgical - adverse effects; Female; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - physiopathology; Hospitals, University; Humans; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; London; Male; Renal Dialysis; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency; London
• ISSN: 1724-6032
• DOI: 10.5301/jva.5000084

There is a limited source of information about vascular access outcomes in HIV-positive patients in the literature. Previous studies have shown autogenous arteriovenous fistulae (AVF) to have similar cumulative survival rates in HIV-positive and negative patients but functional patency has not been assessed. The primary aim of this study was to investigate functional patency of AVFs in HIV-positive patients. A retrospective case-control study identifying 17 HIV-positive patients with AVFs under the care of renal services at Kings College Hospital, London was undertaken. Seventeen HIV-negative controls were matched for age, sex, ethnicity, and co-morbidities. Comparisons were made for pre-operative vein diameter, primary and functional patencies, and post-operative complications. No statistically significant difference was seen for functional patency between AVFs in the HIV-positive and control groups (P=.078). Complications were experienced by five HIV-positive patients (29.4%) and nine of the control group (52.9%). These included aneurysms and pseudoaneurysms for both groups. The difference in pre-operative vein diameter was not significant (P=.102), although only five of the HIV-positive patients had pre-operative vein diameters >=2.5 mm (45.5%) compared to twelve of the controls (75%). This study reveals that there is no statistically significant difference between the functional patency of autogenous AVFs in HIV-positive patients compared to HIV-negative controls. With less than half of the HIV-positive patients having pre-operative vein diameters >=2.5 mm, this suggests that it is still worth creating AVFs in patients with sub-optimal veins considering the known poorer patency with non-autogenous fistulae.