Initial Experience with Capd in Patients with HIV Infection in a Developing Country

Abstract

In 1987 Kenyan physicians began screening patients with end-stage renal disease for HIV antibodies before they began hemodialysis. In 1989 the University of Nairobi Hospital in Kenya initiated its chronic ambulatory peritoneal dialysis (CAPD) program. Between January 1989 and September 1991 9 end-stage renal disease patients who tested positive for HIV but did not have AIDS chose to pay for CAPD themselves. The ages of the 5 females and 4 males ranged from 24 to 48 years (mean 33.6 years). Surgeons used the double-cuff Tenckhoff catheter and the spike connection system. Physicians trained these patients in CAPD for about 2 weeks. During the first week all patients exhibited adequate blood urea nitrogens and serum creatinine levels (15-23) mmol/l and 668-957 mcmol/l respectively). 5-18 days after catheter insertion the patients developed peritonitis compared to 3-14 months for CAPD patients who did not have HIV infection. The rate of peritonitis for the HIV-positive CAPD patients was 8 episodes/12 patient months while that of the other CAPD patients was 2.1 episodes/12 patient months. Health care personnel followed the HIV-infected CAPD patients for 5.8 months before 7 died and 2 were lost to follow-up. They followed the CAPD patients who were not infected with HIV for 26.2 months. Coagulase-negative Staphylococcus and S. aureus were responsible for most of the 35 episodes of peritonitis in the HIV-infected CAPD cases (11 and 8 cases respectively). Even though these cases received the appropriate antibiotics the course of the peritonitis episodes were protracted (10-67 days mean 23.4 days). The peritoneal dialysis effluent tested strongly positive for HIV antibodies in 1 patient and somewhat positive in 3 other patients. The poor performance of these HIV-positive CAPD patients reassured the physicians at the hospital that they should not use CAPD (an expensive treatment) to treat HIV-positive individuals despite WHO recommendation to do so.