Abstract
BackgroundThere are conflicting reports on the impact of HIV in the era of combined antiretroviral (c-ART) on survival of patient with ESKD. We aimed to compare the one-year survival of HIV positive patients to that of their HIV negative counterparts with ESKD on maintenance haemodialysis in Cameroon.MethodsThis was a retrospective cohort study conducted in the haemodialysis units of the Douala and Yaoundé General Hospitals. All HIV positive patients treated by maintenance haemodialysis between January 2007 and March 2015 were included. A comparative group of HIV negative patients with ESKD were matched for age, sex, co morbidities, year of dialysis initiation and haemodialysis unit. Relevant data at the time of haemodialysis initiation and during the first year of haemodialysis was noted. Survival was analysed using the Kaplan Meier and Cox regression hazard ratio estimator. A p value < 0.05 was considered statistically significant.ResultsA total of 57 patients with HIV and 57 without HIV were included. Mean age was 46.25 ± 11.41 years, and 52.6% were females in both groups. HIV nephropathy (50.9%) was the main presumed aetiology of ESKD in the HIV group, while chronic glomerulonephritis (33.3%) and diabetes (21.1%) were the main aetiologies in the HIV negative group. At initiation of dialysis, the median CD4 count was 212 cell/mm3 (IQR; 138–455) and 77.2% were receiving c-ART. The proportion of patients who initiated dialysis with a temporary venous catheter was similar in both groups (p = 0.06). After one year on haemodialysis, survival rate was lower in the HIV positive group compared to the HIV negative group (61.4%/78.9%, HR: 2.05; 95% CI: 1.03–4.08; p = 0.042).Kaplan Meier survival curve was in direction of a lower survival in HIV positive group (p = 0.052).ConclusionThe one year survival of HIV positive patients on maintenance haemodialysis in Cameroon seems to be lower compared to their HIV negative counterparts.
Highlights
There are conflicting reports on the impact of human immune deficiency virus (HIV) in the era of combined antiretroviral (c-ART) on survival of patient with end stage kidney disease (ESKD)
In the USA survival of HIV patients with ESKD was lower compared to HIV negative patients [10, 16], while 2-year survival of treated HIV positive patients on haemodialysis was comparable to HIV-negative ones in France [17]
We included 57 HIV positive patients (21 in Yaoundé and 36 in Douala GH) and they were paired with 57 HIV negative patients according to sex, age, dialysis centre and date of dialysis initiation
Summary
There are conflicting reports on the impact of HIV in the era of combined antiretroviral (c-ART) on survival of patient with ESKD. We aimed to compare the one-year survival of HIV positive patients to that of their HIV negative counterparts with ESKD on maintenance haemodialysis in Cameroon. C- ART is based on the association of three anti-viral drugs that inhibit the HIV replication It was introduced in the care of HIV patients in 1997 and has improved the survival of these patients on renal replacement therapy (RRT) [15]. Reported results on survival of HIV positive patients compared to HIV negative one on haemodialysis are conflicting. Despite the burden of HIV and the improve access to RRT and c-ART in most countries in sub Saharan Africa (SSA), data on survival of HIV patients on RRT are rare. A recent study in South Africa reported a similar survival between HIV positive and negative patients [18]
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