title: Outcome and prognostic factors in HIV-1-infected patients on dialysis in the cART era: a GESIDA/SEN cohort study.
abstract: 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.
authors.affiliation: Hospital Sant Jaume de Olot University of Girona, Girona, Spain.
authors.forename: Joan-Carles
authors.initials: JC
authors.lastname: Trullàs
authors.forename: Federico
authors.initials: F
authors.lastname: Cofan
authors.forename: Guillermina
authors.initials: G
authors.lastname: Barril
authors.forename: Alberto
authors.initials: A
authors.lastname: Martínez-Castelao
authors.forename: Rosa
authors.initials: R
authors.lastname: Jofre
authors.forename: Maite
authors.initials: M
authors.lastname: Rivera
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez-Ara
authors.forename: Silvia
authors.initials: S
authors.lastname: Ros
authors.forename: Iñaki
authors.initials: I
authors.lastname: Perez
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miró
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D015497:HIV-1; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality; D051437:Renal Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents