Patients With Human Immunodeficiency Virus Do Not Have Inferior Outcomes After Dialysis Access Creation
Quinten Dicken, Kristiana Sather, Alik Farber, Douglas Jones, Logan Mendez, Victor Castro, Yixin Zhang, Jeffrey Siracuse.
Boston University, Boston, MA, USA.
Objectives: Patients with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) have been shown to have worse postoperative outcomes and overall survival. As HIV patients are living longer and the prevalence of patients with concurrent HIV and end staged renal disease (ESRD) is increasing, our goal was to assess outcomes of HIV patients undergoing arteriovenous (AV) access creation.
Methods: The Vascular Quality Initiative Registry was queried form 2011-2018 for all patients undergoing AV access creation. Documentation of HIV status, with or without AIDS was recorded. Data was matched 4:1 for non-HIV to HIV/AIDS patients. Subsequent multivariable analysis and Kaplan Meier analysis was performed for short and long-term outcomes.
Results: There were 25,711 upper extremity AV accesses identified – 25,186 without HIV (98%), 424 (1.6%) with HIV and 101 (0.4%) with AIDS. Average age was 61.8 years and 55.8% were male. Patients with HIV/AIDS were more likely to be younger, male, non-white, non-obese, current smokers, on Medicaid, have a history of IV drug use, and less likely to have diabetes, and cardiac comorbidities (P<.05). There was no difference in autogenous or prosthetic access. Multivariable analysis showed that HIV/AIDS did not significantly affect access reintervention (HR 0.97, 95% CI 0.76 – 1.24, P=.81), occlusion (HR 1.06, 95% CI .86 – 1.29, P = .6), or survival (HR 1.08, 95% CI 0.83 – 1.43, P=.57). Kaplan-Meier analysis showed no difference in 1-year freedom from reintervention (61% vs. 60.7%, P = .81), occlusion (43.9% vs. 46.3%, P = 0.6), or 3-year survival for those without HIV compared to those with HIV/AIDS (83% vs. 83.8%, P = 0.57).
Conclusions: Patients with ESRD and HIV/AIDS undergoing AV access creation have similar outcomes to those without HIV, including long-term survival. HIV status should not influence AV access creation and dialysis in this group of patients.
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