Race but not Hepatitis C co-infection affects survival of HIV+ individuals on dialysis in contemporary practice.

Academic Article

Abstract

  • Individuals with HIV infection are at elevated risk of developing end-stage renal disease. However, their outcomes after starting chronic dialysis in the contemporary era of widespread antiretroviral therapy are not well described. Using detailed data from a national dialysis provider, we determined HIV status by administrative codes and antiretroviral medication prescriptions, with hepatitis C virus (HCV) co-infection status provided by routinely measured serology. The survival on dialysis among 5348 individuals in the HIV+ group and 1863 HIV+/HCV+ individuals to a HIV-/HCV- reference cohort was compared. Race significantly modified the effect of HIV and HIV/HCV infection on mortality. In a multivariable model, HIV infection was not associated with an increased risk of death among Caucasians (hazard ratio 1.03, 95% confidence interval 0.91-1.16) but HIV/HCV co-infection (1.48, 1.18-1.87) was. In the same model for non-Caucasians, both HIV infection (1.44, 1.37-1.52) and HIV/HCV co-infection (1.71, 1.60-1.84) were significantly associated with higher mortality. A secondary analysis using propensity scores yielded similar results. Median follow-up for the reference group was 645 days (interquartile range 230-1323), 772 days (276-1623) for the HIV+ group and 777 days (334-1665) for the co-infected group. Thus, in the contemporary era of widespread antiretroviral use, HIV infection remains associated with a significant reduction in dialysis survival for non-Caucasians while HIV/HCV co-infection is associated with impaired survival regardless of race or ethnicity. Hence, interventions to improve the care for these vulnerable populations are needed.
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    Published In

    Keywords

  • ESRD, HCV, HIV, hemodialysis, outcomes, transplant, AIDS-Associated Nephropathy, Adult, Aged, Anti-HIV Agents, Coinfection, Databases, Factual, Female, HIV Infections, Hepatitis C, Humans, Male, Middle Aged, Renal Dialysis, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States
  • Digital Object Identifier (doi)

    Author List

  • Sawinski D; Forde KA; Locke JE; Cohen JB; Weldon J; Shults J; Reese PP
  • Start Page

  • 706
  • End Page

  • 715
  • Volume

  • 93
  • Issue

  • 3