Survival experience of peritoneal dialysis patients with human immunodeficiency virus: a 17-year retrospective study

Human immunodeficiency virus (HIV)-related renal disease is the third-leading cause of end-stage renal disease (ESRD) among African Americans aged 20-64 years. The number of HIV-infected (HIV+) patients reaching ESRD will increase exponentially over the next decade. Because of significant improvements in therapy and management during the last ten years, survival of HIV+ patients has improved. The survival experience of very long-term HIV+ peritoneal dialysis (PD) patients remains to be investigated. The objective of the present study was to examine the important differences in clinical and laboratory parameters between HIV+ and HIV-negative (HIV-) PD patients. To assess the factors associated with better survival in HIV+ PD patients, we retrospectively reviewed the charts of 488 PD patients, including 53 HIV+ patients, for the period 1987 to September 2004. We collected demographic, clinical, and laboratory data, including CD4 cell counts and history of hospitalizations and peritonitis. Maximum survival of HIV+ PD patients was 12.5 years as compared with 15.87 years in HIV-patients. Not surprisingly, HIV was a strong independent predictor of mortality in PD patients [relative risk (RR) = 3.09, p < 0.0001]. In HIV+ patients, higher CD4 counts at the initiation of dialysis were strongly associated with better survival (RR = 0.10 and p < 0.0001, > or =200 cells/mm3 vs. < or =50 cells/mm3). In univariate analysis, use of highly active antiretroviral therapy (HAART) was associated with significantly improved survival in HIV+ PD patients. Patients treated with I or 2 drugs had a 4.3-times higher mortality risk than those who received HAART therapy (p = 0.012). Independent associations were seen between HIV and younger age, African American race, male sex, and lower serum albumin. The rates of hospitalization (p < 0.0001) and peritonitis (p < 0.01) were significantly higher in HIV+ patients than in HIV-patients. Very long-term survival of HIV+ patients with chronic renal failure is possible on PD therapy. Morbidity and mortality of these patients may be improved with HAART therapy, better nutrition, and treatment of peritonitis.