Human Immunodeficiency Virus Infection in End‐Stage Renal Disease Patients

Abstract

Human immunodeficiency virus (HIV) infection in patients with end-stage renal disease (ESRD) offers many diagnostic and therapeutic challenges to nephrologists. Renal failure may be a direct consequence of viral infection (HIV-associated nephropathy), or intrinsic renal diseases may occur in previously infected individuals. Patients receiving renal replacement therapy (RRT) may acquire HIV infection from blood transfusions, renal allografts, sexual contacts, or needle sharing by drug addicts. In the early 1980s, the overall prognosis of patients with the acquired immunodeficiency syndrome (AIDS) was very poor, and survival of those with ESRD was dismal. Consequently many even questioned the value of providing maintenance dialysis to patients with AIDS. With advances in diagnostic techniques in serologic and viral markers of disease, and deployment of highly effective antiretroviral agents, the prognosis of HIV-infected patients has dramatically improved. Over the past two decades, experiences in the management of HIV patients with ESRD is accumulating. Both peritoneal dialysis and hemodialysis are effective modes of therapy and many centers are now beginning to perform renal transplantation in HIV-infected patients. This article deals with various aspects of HIV infection in patients with ESRD.

Survival and morbidity of HIV patients on hemodialysis and peritoneal dialysis: one center’s experience and review of the literature

“…In patients who may require frequent hospitalizations for opportunistic infections or malignancy, maintenance HD may be a better alternative because it avoids the additional risk of peritonitis. Also CAPD may aggravate the malnutrition and hypoalbuminemia in HIV patients with severe wasting syndrome [1].…”

“…In HIV patients, both peritoneal dialysis and hemodialysis are effective forms of renal replacement therapy (RRT), although rates of complicating infections are high. The prognosis of HIV-infected ESRD patients treated by maintenance dialysis was dismal in the early 1980s but it has improved because of highly effective anti-retroviral agents [1].…”

“…Since the absolute number of CD4-positive T-lymphocytes of patients with HIVAN reported in most studies is less than 200, for the most part HIVAN is a late rather than an early complication of HIV infection. Probably this explains why the survival is poorer in HIVAN patients receiving maintenance dialysis than in those who acquired infection during RRT [1].…”

A 20-year history of childhood HIV-associated nephropathy

“…Several excellent reviews have been written describing the progress made in the treatment of HIVAN during the last 20 years [149,150,151,152,153,154]. Unfortunately, most previous studies were performed before the HAART era and excluded children.…”

Dialyzing a Patient with Human Immunodeficiency Virus Infection: What a Nephrologist Needs to Know

“…Another 354 ESRD patients had AIDS but renal failure was attributed to other causes. Subsequently, the incidence of ESRD from HIVAN declined to 2.5% (155 of 6,291) during 1999 and 2% (130 of 6,563) during 2000 [14, 15]. Although ESRD in HIV-infected patients is largely attributed to HIVAN, the number of patients that had the diagnosis confirmed by renal biopsies is unavailable either from the CDC or the USRDS database.…”