Outcome and prognosis factors in HIV-infected hemodialysis patients.
HIV-infected patients who are on hemodialysis have a worse prognosis than noninfected patients who are on hemodialysis. Their outcome in the highly active antiretroviral therapy (HAART) era remains unclear. Outcomes in patients who were enrolled in the French Dialysis in HIV/AIDS (DIVA) cohort were determined in a 2-yr prospective follow-up. All HIV-infected patients who were on hemodialysis in France on January 1, 2002, were included and followed prospectively until January 1, 2004. Patients' survival was examined by Kaplan-Meier method, and mortality risk factors were examined using uni- and multicovariate analyses. Survival was compared with that of 584 hemodialysis patients who did not have HIV or diabetes and were enrolled in the French Dialysis Outcomes and Practice Patterns Study II (DOPPS II) in the same period (after standardization for the average age, gender, and ethnicity of the DIVA cohort). A total of 27,577 patients were receiving hemodialysis in France at the beginning of the study; 164 (0.59%) were infected with HIV, 72% were male, mean age was 44.8 +/- 10.9 yr, and 65% were black. The 2-yr survival rate was 89 +/- 2% and statistically indistinguishable from the survival of the French cohort extracted from the DOPPS II study. Significant mortality risk factors were low CD4 cell count (hazard ratio [HR] 1.4/100 CD4 cells per mm(3) lower), high viral load (HR 2.5/1 Log per ml), absence of HAART (HR 2.7), and a history of opportunistic infection (HR 3.7), the last two being independent (HR 2.6 and 3.6, respectively). Survival of HIV-infected patients who are hemodialysis has greatly improved. A prospective cohort of paired hemodialysis patients with and without HIV is required to compare better their mortality in the HAART era.
Tourret
Jérôme
J
Department of Nephrology, Hôpital Pitié-Salpêtrière, Paris, France. jtourret@yahoo.com
Tostivint
Isabelle
I
du Montcel
Sophie Tézenas
ST
Bragg-Gresham
Jennifer
J
Karie
Svétlana
S
Vigneau
Cécile
C
Guiard-Schmid
Jean-Baptiste
JB
Deray
Gilbert
G
Bagnis
Corinne Isnard
CI
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D019694:Hepatitis B, Chronic / Q000150:complications / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome