Barth RH
Long survival of chronically dialyzed patients with HIV disease
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1439 1996
Renal failure suppresses immunity, and both peritoneal and hemodialysis are
fraught with a number of infectious complications. Hence, the early reports
of short survival on dialysis of HIV-infected patients led to pessimistic
opinions as to whether it was worth dialyzing people with HIV at all.
In this study the author looked at all HIV-infected patients dialyzed at his
hospital over a 10-year period.
There were 36 such patients, 16 of whom had
HIV nephropathy and many of whom were ex-addicts. 32 received hemodialysis
and 4 were on CAPD. The hemodialysis patients were treated with
biocompatible sulfone membrane dialyzers and had a high urea reduction rate.
Mean survival for the group was 15 months, and 21% were alive at 4 years.
For those patients surviving more than 6 months, median survival was 35
months.
Comment: Clearly, then, HIV infection per se does not guarantee rapid
deterioration
in dialysis, even for patients with diagnosed HIV nephropathy, who were all
but written off in the first reports of the disease. These results confirm
a smaller study by Feinfeld et al. which showed that with good treatment,
survival of AIDS patients on dialysis was similar to those not needing
dialysis. Now that new anti-HIV regimens can clear the virus from the
blood, we should offer non-terminal HIV patients with uremia the same
quality treatment as the others.
(Don Feinfeld MD, State University of New York at Stony Brook)
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