Dialysis access creation in the modern era of combined antiretroviral therapy in HIV patients
Abigail E. Barger, David Dexter, MD, Limael E. Rodriguez, MD, Jurabek Babadjanov, MD, Catherine Derber, MD, Animesh Rathore, MD, Jean M. Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
Background: We describe arteriovenous access creation outcomes in the setting of active human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in the modern combination antiretroviral therapy (cART) era. We compare intermediate term outcomes associated with dialysis access creation in patients diagnosed with HIV with or without AIDS at the time of the index procedure.
A retrospective chart review of patients with HIV that underwent dialysis access creation between January 2012 to December 2017 was performed. The patients were followed longitudinally for 2 years. HIV without AIDS (“HIV”) was defined as a CD4 count ≥ 200 (cells/mm3) with an HIV confirmed viral load. HIV with AIDS (“AIDS”) was defined as a CD4 count < 200 with an HIV confirmed viral load. Exclusion criteria were patients younger than 18 or older than 90 years or unconfirmed HIV at index procedure. The primary outcomes were secondary patency, access complications and 2 year mortality.
51 patients (mean age of 49, 69% male, 92% African American) were identified with 65 dialysis access creations. We compared the HIV group (n=38) at time of index operation to the AIDS group (n=27). AIDS patients had higher prevalence of HIV related nephropathy (68% vs 35%, p=0.02), fewer previous access procedures (16% vs 54%, p=0.01) and were on fewer antiviral medications (2 vs 3, p<0.001) at the time of index procedure. All other demographic factors were the similar between groups. The CD4 count was significantly lower at index procedure in patients with AIDS (63 vs 463, p<0.001). Native AV fistulas were placed in AIDS patients in 81% of cases vs 66%, HIV patients p=0.16. There was no significant difference between the groups incidence of thrombosis (15% vs 18%, p=0.70), stenosis (63% vs 45%, p=0.15), or infection (7.4% vs 2.6%, p=0.37). Secondary patency at 2 years was 59% and 57% (p=0.89). There was no difference in mortality at 2 years (20% vs 15%, p=0.67).
Dialysis access creation in the modern era of cART is associated with good outcomes regardless of HIV/AIDS status. We found no difference between the groups at intermediate follow up for complications, secondary patency at 2 years, or mortality. We suggest that patients with HIV should be considered for AV access creation without bias based upon their stage of disease progression.
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