title: Arteriovenous access outcomes in haemodialysis patients with HIV infection.
abstract: BACKGROUND
  Arteriovenous (AV) grafts in haemodialysis patients usually fail due to thrombosis or infection. There is limited information on whether graft outcomes in HIV-positive haemodialysis patients differ from those in HIV-negative controls.
  
  
  METHODS
  Using a prospective, computerized vascular access database, we identified retrospectively 15 HIV-positive dialysis patients having a graft placed during a 6.5-year period (January 1999 to June 2005), and compared their graft outcomes to those observed in 30 age-, sex- and access date-matched HIV-negative control patients. In addition, the outcomes of AV fistulas in 23 HIV-positive patients were compared with those observed in 32 matched HIV-negative controls.
  
  
  RESULTS
  Thrombosis-free graft survival was substantially worse among the HIV-positive patients than in the HIV-negative controls (1-year survival, 17% vs 62%). The hazard ratio for graft thrombosis in the HIV-positive patients was 3.22 (95% CI, 1.66-10.32, P = 0.002). Infection-free graft survival was also lower in HIV-positive patients (hazard ratio 3.51; 95% CI, 1.21-18.85, P = 0.025). Finally, cumulative graft survival (from creation until permanent failure) tended to be lower in HIV-positive patients (1 year survival, 41% vs 65%, P = 0.07). The primary failure rate of fistulas (those never usable for dialysis) was similar in HIV-positive patients and in their controls (44% vs 41%, P = 0.83). Cumulative fistula survival was similar for HIV-positive and negative patients (hazard ratio 1.32; 95% CI, 0.65-3.58, P = 0.33).
  
  
  CONCLUSIONS
  AV grafts have inferior outcomes in HIV-positive patients as compared with HIV-negative patients, whereas fistulas have a similar survival in both groups.
authors.affiliation: Division of Nephrology, 728 Richard Arrington Blvd, Birmingham, AL 35233, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Mitchell
authors.forename: Zipporah
authors.initials: Z
authors.lastname: Krishnasami
authors.forename: Carlton J
authors.initials: CJ
authors.lastname: Young
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*