Evolución clínica de los enfermos renales crónicos en tratamiento sustitutivo con infección por VIH

Abstract

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 2004-2011 (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 1,000 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.

Hepatitis B and C among healthcare workers and patient groups at increased risk of iatrogenic transmission in the European Union/European Economic Area

“…Of the 17 studies on HCV prevalence among haemodialysis patients, those reporting estimates in the upper range were either conducted in the late 1990s and early 2000s (12.5–29%) [17] , [31] , [32] , [33] , [34] , [35] , or reported data from Romania (27.3–39.3%) [18] , [19] . The highest reported estimate (53.1%) is derived from a study conducted among HIV-infected patients in Spain [20] . Finally, a prospective, multicentre, cohort study provides an overall estimate of 6.7% HCV prevalence among haemodialysis patients from across seven EU/EEA countries, namely Belgium, Italy, France, Germany, Spain, Sweden and UK [36] .…”

“…However, data on coverage among the target population was hardly available, hampering the possibility of assessing the impact of such intervention on the burden of HBV. Furthermore, higher HBV prevalence estimates among haemodialysis patients were reported from those countries with higher prevalence among the general population, thus reflecting the underlying epidemiological profile [1] , with the exception of one study from Spain [20] conducted among HIV-positive patients. As a comparison, the few studies on diabetes patients report prevalence estimates comparable to those observed for the general population in the corresponding countries.…”

“…The six studies on haemodialysis patients were conducted in the period 2001–2011 and present data from five EU/EEA countries, with the highest prevalence rates reported in studies conducted in Lithuania and Romania [17] , [18] , [19] . One study from Spain [20] reports relatively high prevalence of HBV (7.8%) among a sample of haemodialysis patients living with HIV. All four studies reporting on SOHO recipients were performed in the early 2000s, some sampled patients hospitalized before 1991 [21] , [22] and some sampled HIV- or HCV-infected individuals [23] , [24] .…”

“…Still, considering the recommendation of WHO to promote active case finding for HCV among population subgroups with prevalence above the 2% threshold [63] , the groups identified in our study, haemodialysis recipients, recipients of SOHO and diabetic patients, should be targeted for testing in the EU/EEA. High range estimates were detected in those studies sampling patients with overlapping risks such as HIV infection [20] , [23] , thus underlying the importance of performing individual risk assessment to identify patients who might benefit from testing for HCV.…”

HIV and kidney diseases: 35 years of history and consequences

“…In a German renal biopsy study, immune complex-mediated glomerulonephritis (26.1%), hypertensive (20.3%) and diabetic nephropathy (20.3%) were the most frequent causes of CKD in HIV patients and the latter two accounted for over 50% of cases in more recent years [65], while arterionephrosclerosis was the most common kidney diagnosis in a post-mortem American series [7]. Diabetic nephropathy was the cause of ESRD in 14% of HIV-positive patients in Spain [6]. Indeed, nephropathy was more common in HIV-infected than uninfected diabetic patients [66], and expression of an HIV transgene aggravated kidney injury in diabetic mice [67].…”