Human immunodeficiency virus and dialysis
- Paul E Klotman, MD
Paul E Klotman, MD
- President, CEO, and Executive Dean
- Baylor College of Medicine
- Christina M Wyatt, MD
Christina M Wyatt, MD
- Associate Professor
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
Kidney disease is an important complication of human immunodeficiency virus (HIV) infection, particularly in African Americans . A collapsing form of focal segmental glomerulosclerosis (FSGS) with associated tubular microcysts and interstitial inflammation is the classic form of HIV-related kidney disease, known as HIV-associated nephropathy (HIVAN). HIV infection has also been associated with other forms of kidney disease, in particular, immune complex disease . With prolonged survival and aging of the population, HIV-positive patients are also at increasing risk for kidney disease due to comorbid conditions, such as diabetes and hypertension.
Some of these kidney diseases can result in end-stage renal disease (ESRD). Issues relating to HIV and dialysis will be reviewed here. HIV-related disorders of the kidney are discussed separately. (See "Overview of kidney disease in HIV-positive patients" and "HIV-associated nephropathy (HIVAN)".)
Compared with the general population, HIV-positive patients are at increased risk for end-stage renal disease (ESRD). In a population-based cohort study from Denmark, HIV-positive individuals had a fourfold higher risk of ESRD compared with age- and gender-matched controls . Data from the Veterans Affairs (VA) healthcare system have demonstrated that the risk of ESRD is associated with both HIV-related factors (high HIV-RNA, low CD4, and hepatitis C virus coinfection) and traditional kidney disease risk factors (diabetes, hypertension, and cardiovascular disease) . A subsequent study from the VA suggests that ESRD may occur at a younger age in HIV-positive versus HIV-negative veterans, although the difference is small .
Both HIV-related factors and traditional renal risk factors were also associated with a combined endpoint of ESRD and advanced chronic kidney disease in two large HIV cohort studies, D:A:D and EuroSIDA [6,7]. In a smaller, retrospective cohort study from Germany, injection drug use and black race were the only independent risk factors for ESRD in HIV-positive adults . Over the 20-year study period, these authors observed a decline in the prevalence of ESRD among HIV-positive blacks and an increase in the prevalence of ESRD among HIV-positive whites, although the racial disparity in ESRD risk remained significant.
Data from the VA healthcare system and from the Johns Hopkins HIV cohort have also demonstrated a striking disparity in the risk of ESRD among HIV-positive blacks, who may have as much as a 30-fold increase in the risk of ESRD compared with HIV-positive whites [9-11]. In the VA cohort, the risk of ESRD among HIV-positive blacks was similar to that observed among diabetics . Genetic variability in the APOL1 gene on chromosome 22 appears to account for a significant proportion of the racial disparity in ESRD risk, including the risk of HIV-associated nephropathy (HIVAN) and other forms of focal segmental glomerulosclerosis (FSGS) [12-14]. (See "Epidemiology, classification, and pathogenesis of focal segmental glomerulosclerosis", section on 'FSGS in African Americans'.)
- Wyatt CM, Winston JA, Malvestutto CD, et al. Chronic kidney disease in HIV infection: an urban epidemic. AIDS 2007; 21:2101.
- Gerntholtz TE, Goetsch SJ, Katz I. HIV-related nephropathy: a South African perspective. Kidney Int 2006; 69:1885.
- Rasch MG, Helleberg M, Feldt-Rasmussen B, et al. Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population. Nephrol Dial Transplant 2014; 29:1232.
- Jotwani V, Li Y, Grunfeld C, et al. Risk factors for ESRD in HIV-infected individuals: traditional and HIV-related factors. Am J Kidney Dis 2012; 59:628.
- Althoff KN, McGinnis KA, Wyatt CM, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis 2015; 60:627.
- Ryom L, Mocroft A, Kirk O, et al. Predictors of advanced chronic kidney disease and end-stage renal disease in HIV-positive persons. AIDS 2014; 28:187.
- Ryom L, Kirk O, Lundgren JD, et al. Advanced chronic kidney disease, end-stage renal disease and renal death among HIV-positive individuals in Europe. HIV Med 2013; 14:503.
- Bickel M, Marben W, Betz C, et al. End-stage renal disease and dialysis in HIV-positive patients: observations from a long-term cohort study with a follow-up of 22 years. HIV Med 2013; 14:127.
- Choi AI, Rodriguez RA, Bacchetti P, et al. Racial differences in end-stage renal disease rates in HIV infection versus diabetes. J Am Soc Nephrol 2007; 18:2968.
- Lucas GM, Mehta SH, Atta MG, et al. End-stage renal disease and chronic kidney disease in a cohort of African-American HIV-infected and at-risk HIV-seronegative participants followed between 1988 and 2004. AIDS 2007; 21:2435.
- Lucas GM, Lau B, Atta MG, et al. Chronic kidney disease incidence, and progression to end-stage renal disease, in HIV-infected individuals: a tale of two races. J Infect Dis 2008; 197:1548.
- Kao WH, Klag MJ, Meoni LA, et al. MYH9 is associated with nondiabetic end-stage renal disease in African Americans. Nat Genet 2008; 40:1185.
- Kopp JB, Smith MW, Nelson GW, et al. MYH9 is a major-effect risk gene for focal segmental glomerulosclerosis. Nat Genet 2008; 40:1175.
- Genovese G, Friedman DJ, Ross MD, et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science 2010; 329:841.
- Perez G, Ortiz-Interian C, Lee H, et al. Human immunodeficiency virus and human T-cell leukemia virus type I in patients undergoing maintenance hemodialysis in Miami. Am J Kidney Dis 1989; 14:39.
- Vigneau C, Guiard-Schmid JB, Tourret J, et al. The clinical characteristics of HIV-infected patients receiving dialysis in France between 1997 and 2002. Kidney Int 2005; 67:1509.
- US Renal Data System, 2009 Annual Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, 2009.
- US Preventive Services Task Force. Final Recommendation Statement. Human Immunodeficiency Infection (HIV): Screening, April 2013. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/human-immunodeficiency-virus-hiv-infection-screening (Accessed on March 12, 2016).
- Wali RK, Drachenberg CI, Papadimitriou JC, et al. HIV-1-associated nephropathy and response to highly-active antiretroviral therapy. Lancet 1998; 352:783.
- Winston JA, Bruggeman LA, Ross MD, et al. Nephropathy and establishment of a renal reservoir of HIV type 1 during primary infection. N Engl J Med 2001; 344:1979.
- Peterman TA, Lang GR, Mikos NJ, et al. HTLV-III/LAV infection in hemodialysis patients. JAMA 1986; 255:2324.
- Ujhelyi E, Füst G, Illei G, et al. Different types of false positive anti-HIV reactions in patients on haemodialysis. Immunol Lett 1989; 22:35.
- Arnow PM, Fellner S, Harrington R, Leuther M. False-positive results of screening for antibodies to human immunodeficiency virus in chronic hemodialysis patients. Am J Kidney Dis 1988; 11:383.
- Vardinon N, Yust I, Katz O, et al. Anti-HIV indeterminate western blot in dialysis patients: a long-term follow-up. Am J Kidney Dis 1999; 34:146.
- Chou CC, Sun CY, Wu MS. Human immunodeficiency virus (HIV) infection screening in a dialysis unit. Ren Fail 2007; 29:459.
- Ahuja TS, O'brien WA. Special issues in the management of patients with ESRD and HIV infection. Am J Kidney Dis 2003; 41:279.
- Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001; 50:1.
- Centers for Disease Control and Prevention (CDC). HIV transmission in a dialysis center--Colombia, 1991-1993. MMWR Morb Mortal Wkly Rep 1995; 44:404.
- Dyer E. Argentinian doctors accused of spreading AIDS. BMJ 1993; 307:584.
- Velandia M, Fridkin SK, Cárdenas V, et al. Transmission of HIV in dialysis centre. Lancet 1995; 345:1417.
- El Sayed NM, Gomatos PJ, Beck-Sagué CM, et al. Epidemic transmission of human immunodeficiency virus in renal dialysis centers in Egypt. J Infect Dis 2000; 181:91.
- Centers for Disease Control and Prevention. Frequently Asked Questions—Bloodborne Pathogens—Occupational Exposure. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf (Accessed on March 12, 2016).
- Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997; 337:1485.
- Ahuja TS, Niaz N, Velasco A, et al. Effect of hemodialysis and antiretroviral therapy on plasma viral load in HIV-1 infected hemodialysis patients. Clin Nephrol 1999; 51:40.
- Breyer JA, Harbison MA. Isolation of human immunodeficiency virus from peritoneal dialysate. Am J Kidney Dis 1993; 21:23.
- Scheel PJ Jr, Farzadegan H, Ford D, et al. Recovery of human immunodeficiency virus from peritoneal dialysis effluent. J Am Soc Nephrol 1995; 5:1926.
- Farzadegan H, Ford D, Malan M, et al. HIV-1 survival kinetics in peritoneal dialysis effluent. Kidney Int 1996; 50:1659.
- Ahuja TS, Collinge N, Grady J, Khan S. Is dialysis modality a factor in survival of patients with ESRD and HIV-associated nephropathy? Am J Kidney Dis 2003; 41:1060.
- Brock JS, Sussman M, Wamsley M, et al. The influence of human immunodeficiency virus infection and intravenous drug abuse on complications of hemodialysis access surgery. J Vasc Surg 1992; 16:904.
- Curi MA, Pappas PJ, Silva MB Jr, et al. Hemodialysis access: influence of the human immunodeficiency virus on patency and infection rates. J Vasc Surg 1999; 29:608.
- Mitchell D, Krishnasami Z, Young CJ, Allon M. Arteriovenous access outcomes in haemodialysis patients with HIV infection. Nephrol Dial Transplant 2007; 22:465.
- Fokou M, Teyang A, Ashuntantang G, et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg 2012; 26:680.
- Nannery WM, Stoldt HS, Fares LG 2nd. Hemodialysis access operations performed upon patients with human immunodeficiency virus. Surg Gynecol Obstet 1991; 173:387.
- Lucas GM, Ross MJ, Stock PG, et al. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e96.
- Mitchell D, Krishnasami Z, Allon M. Catheter-related bacteraemia in haemodialysis patients with HIV infection. Nephrol Dial Transplant 2006; 21:3185.
- Obialo CI, Robinson T, Brathwaite M. Hemodialysis vascular access: variable thrombus-free survival in three subpopulations of black patients. Am J Kidney Dis 1998; 31:250.
- Tebben JA, Rigsby MO, Selwyn PA, et al. Outcome of HIV infected patients on continuous ambulatory peritoneal dialysis. Kidney Int 1993; 44:191.
- Dressler R, Peters AT, Lynn RI. Pseudomonal and candidal peritonitis as a complication of continuous ambulatory peritoneal dialysis in human immunodeficiency virus-infected patients. Am J Med 1989; 86:787.
- Lewis M, Gorban-Brennan NL, Kliger A, et al. Incidence and spectrum of organisms causing peritonitis in HIV positive patients on CAPD. Adv Perit Dial 1990; 6:136.
- Elsey RM, Carson RW, DuBose TD Jr. Pasteurella multocida peritonitis in an HIV-positive patient on continuous cycling peritoneal dialysis. Am J Nephrol 1991; 11:61.
- Parsonnet J. Trichosporon beigelii peritonitis. South Med J 1989; 82:1062.
- Varela MP, Lew SQ, Smith AM, et al. Outcome of an opportunistic infection after polymicrobial peritonitis in an HIV-infected patient treated with peritoneal dialysis. Am J Nephrol 1999; 19:682.
- Perazella M, Eisen T, Brown E. Peritonitis associated with disseminated Mycobacterium avium complex in an acquired immunodeficiency syndrome patient on chronic ambulatory peritoneal dialysis. Am J Kidney Dis 1993; 21:319.
- Kimmel PL, Umana WO, Simmens SJ, et al. Continuous ambulatory peritoneal dialysis and survival of HIV infected patients with end-stage renal disease. Kidney Int 1993; 44:373.
- Wasser WG, Boyle MJ, Brandon S, et al. HIV positivity does not predispose peritoneal dialysis patients to peritonitis. J Am Soc Nephrol 1991; 2:369.
- Troidle L, Kliger AS, Goldie SJ, et al. Continuous peritoneal dialysis-associated peritonitis of nosocomial origin. Perit Dial Int 1996; 16:505.
- Kiernan L, Finkelstein FO, Kliger AS, et al. Outcome of polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 1995; 25:461.
- Shrivastava D, Rao TK, Sinert R, et al. The efficacy of erythropoietin in human immunodeficiency virus-infected end-stage renal disease patients treated by maintenance hemodialysis. Am J Kidney Dis 1995; 25:904.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf (Accessed on March 12, 2016).
- Ahuja TS, Borucki M, Grady J. Highly active antiretroviral therapy improves survival of HIV-infected hemodialysis patients. Am J Kidney Dis 2000; 36:574.
- Ifudu O, Mayers JD, Matthew JJ, et al. Uremia therapy in patients with end-stage renal disease and human immunodeficiency virus infection: has the outcome changed in the 1990s? Am J Kidney Dis 1997; 29:549.
- Ahuja TS, Grady J, Khan S. Changing trends in the survival of dialysis patients with human immunodeficiency virus in the United States. J Am Soc Nephrol 2002; 13:1889.
- Macrae J, Friedman AL, Eggers P, Friedman EA. Improved survival in HIV-infected African-Americans with ESRD. Clin Nephrol 2005; 64:124.
- Tourret J, Tostivint I, du Montcel ST, et al. Outcome and prognosis factors in HIV-infected hemodialysis patients. Clin J Am Soc Nephrol 2006; 1:1241.
- Trullàs JC, Cofan F, Barril G, et al. Outcome and prognostic factors in HIV-1-infected patients on dialysis in the cART era: a GESIDA/SEN cohort study. J Acquir Immune Defic Syndr 2011; 57:276.
- Tourret J, Tostivint I, Tézenas Du Montcel S, et al. Antiretroviral drug dosing errors in HIV-infected patients undergoing hemodialysis. Clin Infect Dis 2007; 45:779.
- Choi AI, Rodriguez RA, Bacchetti P, et al. Low rates of antiretroviral therapy among HIV-infected patients with chronic kidney disease. Clin Infect Dis 2007; 45:1633.
- Ortiz C, Meneses R, Jaffe D, et al. Outcome of patients with human immunodeficiency virus on maintenance hemodialysis. Kidney Int 1988; 34:248.
- Perinbasekar S, Brod-Miller C, Pal S, Mattana J. Predictors of survival in HIV-infected patients on hemodialysis. Am J Nephrol 1996; 16:280.
- Dave MB, Shabih K, Blum S. Maintenance hemodialysis in patients with HIV-associated nephropathy. Clin Nephrol 1998; 50:367.
- Atta MG, Fine DM, Kirk GD, et al. Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland. Clin Infect Dis 2007; 45:1625.
- Oberai PC, Dalal D, Zhang L, et al. Incidence of atherosclerotic cardiovascular disease among HIV patients receiving dialysis. Am J Kidney Dis 2006; 47:848.
- Tsiodras S, Mantzoros C, Hammer S, Samore M. Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy: a 5-year cohort study. Arch Intern Med 2000; 160:2050.
- Strategies for Management of Anti-Retroviral Therapy/INSIGHT, DAD Study Groups. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients. AIDS 2008; 22:F17.
- D:A:D Study Group, Sabin CA, Worm SW, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 2008; 371:1417.
- Worm SW, Sabin C, Weber R, et al. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study. J Infect Dis 2010; 201:318.
- Obel N, Farkas DK, Kronborg G, et al. Abacavir and risk of myocardial infarction in HIV-infected patients on highly active antiretroviral therapy: a population-based nationwide cohort study. HIV Med 2010; 11:130.
- Brothers CH, Hernandez JE, Cutrell AG, et al. Risk of myocardial infarction and abacavir therapy: no increased risk across 52 GlaxoSmithKline-sponsored clinical trials in adult subjects. J Acquir Immune Defic Syndr 2009; 51:20.
- Prevalence of human immunodeficiency virus infection in the dialysis population
- HUMAN IMMUNODEFICIENCY VIRUS TESTING
- False-positive results
- TRANSMISSION IN THE DIALYSIS UNIT
- Dialysis isolation
- Patient-to-patient transmission
- Needlestick transmission
- Viral levels in ultrafiltrate
- ISSUES RELATED TO DIALYSIS MODALITY
- Hemodialysis access infections and complications
- Dialyzer reuse
- ANTIRETROVIRAL THERAPY
- SUMMARY AND RECOMMENDATIONS