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Elzouki AN, Habas E, Habas A, Elgamal M, Shraim B, Moursi M, Ibrahim A, Danjuma M. Common complications of hemodialysis: A clinical review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2021. [DOI: 10.4103/ijmbs.ijmbs_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oshiro N, Kohagura K, Tsuneyoshi S, Tateyama M, Zamami R, Uehara H, Fujita J, Ohya Y. Changes in serum concentration of rilpivirine in an HIV-infected patient treated with a combination therapy of hemodialysis and peritoneal dialysis. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To our knowledge, there are no preexisting reports concerning rilpivirine (RPV) removal by hemodialysis and peritoneal dialysis.
Case presentation
This study aimed to evaluate the effect of hemodialysis and peritoneal dialysis on plasma concentrations of RPV in a 45-year-old man infected with HIV and exhibiting end-stage renal disease (ESRD). The extraction ratio of RPV by hemodialysis was 4.5%. Plasma concentrations of RPV remained far above the protein-binding-adjusted inhibitory levels during a combination therapy of hemodialysis and peritoneal dialysis. Our results suggest minimal RPV removal via hemodialysis and peritoneal dialysis with no specific dosage adjustments required in an HIV-infected patient undergoing this combination therapy.
Conclusion
In conclusion, this study showed that RPV administered without dose adjustment resulted in steady-state plasma drug concentration in an HIV-infected patient treated with a combination therapy of hemodialysis and peritoneal dialysis.
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Halle MP, Edjomo AM, Fouda H, Djantio H, Essomba N, Ashuntantang GE. Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study. BMC Nephrol 2018; 19:166. [PMID: 29976156 PMCID: PMC6034298 DOI: 10.1186/s12882-018-0964-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background 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. Methods This 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. Results A 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). Conclusion The one year survival of HIV positive patients on maintenance haemodialysis in Cameroon seems to be lower compared to their HIV negative counterparts.
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Affiliation(s)
- Marie Patrice Halle
- Faculty of Medicine and Pharmaceutical Sciences, Department of internal medicine-Douala general hospital Cameroon, University of Douala, Douala, PO Box: 4856, Cameroon.
| | - Anais Mfoula Edjomo
- Faculty of Medicine and Pharmaceutical Sciences, Department of internal medicine-Douala general hospital Cameroon, University of Douala, Douala, PO Box: 4856, Cameroon
| | - Hermine Fouda
- Faculty of Medicine and Biomedical Sciences, Department of internal medicine- Douala general hospital Cameroon, Douala, University of Yaoundé I, Cameroon
| | - Hilaire Djantio
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon
| | - Noel Essomba
- Faculty of Medicine and Pharmaceutical Sciences, Department of internal medicine-Douala general hospital Cameroon, University of Douala, Douala, PO Box: 4856, Cameroon
| | - Gloria Enow Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Department of internal medicine- Douala general hospital Cameroon, Douala, University of Yaoundé I, Cameroon
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Locke JE, Mehta S, Sawinski D, Gustafson S, Shelton BA, Reed RD, MacLennan P, Bolch C, Durand C, Massie A, Mannon RB, Gaston R, Saag M, Overton T, Segev DL. Access to Kidney Transplantation among HIV-Infected Waitlist Candidates. Clin J Am Soc Nephrol 2017; 12:467-475. [PMID: 28232406 PMCID: PMC5338712 DOI: 10.2215/cjn.07460716] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney transplantation among HIV-infected patients with ESRD confers a significant survival benefit over remaining on dialysis. Given the high mortality burden associated with dialysis, understanding access to kidney transplantation after waitlisting among HIV+ candidates is warranted. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the Scientific Registry of Transplant Recipients were linked to Intercontinental Marketing Statistics pharmacy fills (January 1, 2001 to October 1, 2012) so that we could identify and study 1636 HIV+ (defined as having filled one or more antiretroviral medications unique to HIV treatment) and 72,297 HIV- kidney transplantation candidates. RESULTS HIV+ waiting list candidates were more often young (<50 years old: 62.7% versus 37.6%; P<0.001), were more often men (75.2% versus 59.3%; P<0.001), were more often black (73.6% versus 27.9%; P<0.001), had longer time on dialysis (years: 2.5 versus 0.8; P<0.001), were more often coinfected with hepatitis C virus (9.0% versus 3.9%; P<0.001), and were less likely to remain active on the waiting list (37.7% versus 49.4%; P<0.001). Waitlist mortality among HIV+ candidates was similar compared with HIV- candidates (adjusted hazard ratio, 1.03; 95% confidence interval, 0.89 to 1.20; P=0.67). In contrast, likelihood of living donor kidney transplantation was 47% lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.44 to 0.64; P<0.001), and there was a trend toward lower likelihood of deceased donor kidney transplantation (adjusted hazard ratio, 0.87; 95% confidence interval, 0.74 to 1.01; P=0.07) compared with in HIV- candidates. CONCLUSIONS Our findings highlight the need for additional study to better understand disparities in access to kidney transplantation, particularly living donor kidney transplantation, among HIV+ kidney waitlist candidates.
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Affiliation(s)
| | - Shikha Mehta
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Deirdre Sawinski
- Department of Medicine, University of Pennsylvania Comprehensive Transplant Center, Philadelphia, Pennsylvania
| | - Sally Gustafson
- Department of Analytics, Scientific Registry of Transplant Recipients, Minneapolis, Minnesota; and Departments of
| | | | | | | | - Charlotte Bolch
- Department of Analytics, Scientific Registry of Transplant Recipients, Minneapolis, Minnesota; and Departments of
| | | | - Allan Massie
- Surgery, Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland
| | - Roslyn B. Mannon
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Robert Gaston
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Michael Saag
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Turner Overton
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Dorry L. Segev
- Surgery, Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland
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Long-term Outcomes After Liver Transplantation Among Human Immunodeficiency Virus-Infected Recipients. Transplantation 2016; 100:141-6. [PMID: 26177090 DOI: 10.1097/tp.0000000000000829] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early outcomes after human immunodeficiency virus (HIV) + liver transplantation (LT) are encouraging, but data are lacking regarding long-term outcomes and comparisons with matched HIV- patients. METHODS We examined outcomes among 180 HIV+ LT, and compared outcomes to matched HIV- counterfactuals (Scientific Registry of Transplant Recipients 2002-2011). Iterative expanding radius matching (1:10) on recipient age, race, body mass index, hepatitis C virus (HCV), model for end-stage liver disease score, and acute rejection; and donor age and race, cold ischemia time, and year of transplant. Patient survival and graft survival were estimated using Kaplan-Meier methodology and compared using log-rank and Cox proportional hazards. Subgroup analyses were performed by transplant era (early: 2002-2007 vs. modern: 2008-2011) and HCV infection status. RESULTS Compared to matched HIV- controls, HIV+ LT recipients had a 1.68-fold increased risk for death (adjusted hazard ratio [aHR], 1.68, 95% confidence interval [95% CI], 1.28-2.20; P < 0.001), and a 1.70-fold increased risk for graft loss (aHR, 1.70; 95% CI, 1.31-2.20; P < 0.001). These differences persisted independent of HCV infection status. However, in the modern transplant era risk for death (aHR, 1.11; 95% CI, 0.52-2.35; P = 0.79) and graft loss (aHR, 0.89; 95% CI, 0.42-1.88; P = 0.77) were similar between monoinfected and uninfected LT recipients. In contrast, independent of transplant era, coinfected LT recipients had increased risk for death (aHR, 2.24; 95% CI, 1.43-3.53; P < 0.001) and graft loss (aHR, 2.07; 95% CI, 1.33-3.22; P = 0.001) compared to HCV+ alone LT recipients. CONCLUSIONS These results suggest that outcomes among monoinfected HIV+ LT recipients have improved over time. However, outcomes among HIV+ LT recipients coinfected with HCV remain concerning and motivate future survival benefit studies.
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Wang C, Husain K, Zhang A, Centeno BA, Chen DT, Tong Z, Sebti SM, Malafa MP. EGR-1/Bax pathway plays a role in vitamin E δ-tocotrienol-induced apoptosis in pancreatic cancer cells. J Nutr Biochem 2015; 26:797-807. [PMID: 25997867 DOI: 10.1016/j.jnutbio.2015.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/13/2022]
Abstract
The anticancer activity of δ-tocotrienol, a bioactive vitamin E present in whole grain cereals, annatto beans and palm fruit, is strongly dependent on its effect on the induction of apoptosis. δ-Tocotrienol-induced apoptosis is associated with consistent induction in the expression of the proapoptotic protein Bcl-2-associated X protein (Bax). The molecular mechanism by which δ-tocotrienol regulates Bax expression is unknown. We carried out a DNA microarray study that identified δ-tocotrienol induction of the zinc finger transcription factor EGR-1 in pancreatic cancer cells. Here, we provide evidence linking δ-tocotrienol-induced apoptosis in pancreatic cancer cells to EGR-1 regulation of Bax expression. Forced expression of EGR-1 induces Bax expression and apoptosis in pancreatic cancer cells. In contrast, knockdown of δ-tocotrienol-induced EGR-1 by small interfering RNA attenuated δ-tocotrienol-induced Bax expression and reduced δ-tocotrienol-induced apoptosis. Further analyses showed that de novo protein synthesis was not required for δ-tocotrienol-induced EGR-1 expression, suggesting a direct effect of δ-tocotrienol on EGR-1 expression. Furthermore, a chromatin immunoprecipitation assay demonstrated that EGR-1 binds to the Bax gene promoter. Finally, δ-tocotrienol treatment induced Bax expression and activated EGR-1 in the pancreatic neoplastic cells of the PDX-Cre Kras genetically engineered model of pancreatic cancer. Our study provides the first evidence for EGR-1 as a direct target of vitamin E δ-tocotrienol, suggesting that EGR-1 may act as a proapoptotic factor in pancreatic cancer cells via induction of Bax.
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Affiliation(s)
- Chen Wang
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL; Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Kazim Husain
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL
| | - Anying Zhang
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL; Department of School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Barbara A Centeno
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL
| | - Dung-Tsa Chen
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL
| | - Zhongsheng Tong
- Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Säid M Sebti
- Department of Drug Discovery, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL
| | - Mokenge P Malafa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL; Department of Drug Discovery, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL.
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Locke JE, Mehta S, Reed RD, MacLennan P, Massie A, Nellore A, Durand C, Segev DL. A National Study of Outcomes among HIV-Infected Kidney Transplant Recipients. J Am Soc Nephrol 2015; 26:2222-9. [PMID: 25791727 DOI: 10.1681/asn.2014070726] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/24/2014] [Indexed: 02/01/2023] Open
Abstract
Kidney transplantation is a viable treatment for select patients with HIV and ESRD, but data are lacking regarding long-term outcomes and comparisons with appropriately matched HIV-negative patients. We analyzed data from the Scientific Registry of Transplant Recipients (SRTR; 2002-2011): 510 adult kidney transplant recipients with HIV (median follow-up, 3.8 years) matched 1:10 to HIV-negative controls. Compared with HIV-negative controls, HIV-infected recipients had significantly lower 5-year (75.3% versus 69.2%) and 10-year (54.4% versus 49.8%) post-transplant graft survival (GS) (hazard ratio [HR], 1.37; 95% confidence interval [95% CI], 1.15 to 1.64; P<0.001) that persisted when censoring for death (HR, 1.43; 95% CI, 1.12 to 1.84; P=0.005). However, compared with HIV-negative/hepatitis C virus (HCV)-negative controls, HIV monoinfected recipients had similar 5-year and 10-year GS, whereas HIV/HCV coinfected recipients had worse GS (5-year: 64.0% versus 52.0%, P=0.02; 10-year: 36.2% versus 27.0%, P=0.004 [HR, 1.38; 95% CI, 1.08 to 1.77; P=0.01]). Patient survival (PS) among HIV-infected recipients was 83.5% at 5 years and 51.6% at 10 years and was significantly lower than PS among HIV-negative controls (HR, 1.34; 95% CI, 1.08 to 1.68; P<0.01). However, PS was similar for HIV monoinfected recipients and HIV-negative/HCV-negative controls at both times. HIV/HCV coinfected recipients had worse PS compared with HIV-negative/HCV-infected controls (5-year: 67.0% versus 78.6%, P=0.007; 10-year: 29.3% versus 56.23%, P=0.002 [HR, 1.57; 95% CI, 1.11 to 2.22; P=0.01]). In conclusion, HIV-negative and HIV monoinfected kidney transplant recipients had similar GS and PS, whereas HIV/HCV coinfected recipients had worse outcomes. Although encouraging, these results suggest caution in transplanting coinfected patients.
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Affiliation(s)
- Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama;
| | - Shikha Mehta
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama
| | - Allan Massie
- Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, Maryland; and
| | - Anoma Nellore
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine Durand
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Dorry L Segev
- Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, Maryland; and
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Taha H, Newby K, Das A, Das S. Attitude of patients with HIV infection towards organ transplant between HIV patients. A cross-sectional questionnaire survey. Int J STD AIDS 2015; 27:13-8. [PMID: 25614524 DOI: 10.1177/0956462414568902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
Abstract
This study examined the HIV patients' attitudes towards the practice of organ transplant between HIV patients using a cross-sectional survey design. In total, 206 patients participated with a mean age of 42 (±8.8) years. The majority (70%) were black African and women (54%), and 83% described themselves as heterosexual. Most participants (n = 171, 83%) were on treatment, and 159 (93%) had viral load less than 40 copies/ml. Mean duration of illness and mean duration of treatment were 77 (±42.7) and 68 (±41) months, respectively. Of all participants, 128 (62%) reported that they would consider donating either any organ or a specific organ/s to an HIV patient, 33 (16%) would not consider it and 45 (22%) were unsure about donating their organs. Furthermore, 113 (55%) participants would consider receiving an organ from an HIV patient, 37 (18%) would not consider it, and 56 (27%) were unsure. Ninety-eight participants (42%) reported that they would consider both donating and receiving an organ. Multinomial logistic regression analysis found that significantly more Black African than Caucasian participants were unsure about organ donation (p = 0.011, OR = 3.887). Participants with longer duration of infection were significantly less likely to consider receiving an organ from an HIV patient (p = 0.036, OR = 1.297). Overall, the study findings indicated that the majority of participants were in favour of organ transplant between HIV patients. Use of HIV-infected donors could potentially reduce current organ waiting list among HIV patients.
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Affiliation(s)
- Huda Taha
- GU/HIV Medicine, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Katie Newby
- Applied Research Centre in Health and Lifestyle Interventions, Coventry University, Coventry, UK
| | - Archik Das
- School of Medicine, Birmingham University, Birmingham, UK
| | - Satyajit Das
- GU/HIV Medicine, Coventry and Warwickshire Partnership Trust, Coventry, UK
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Kidney disease in children and adolescents with perinatal HIV-1 infection. J Int AIDS Soc 2013; 16:18596. [PMID: 23782479 PMCID: PMC3687339 DOI: 10.7448/ias.16.1.18596] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/14/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022] Open
Abstract
Introduction Involvement of the kidney in children and adolescents with perinatal (HIV-1) infection can occur at any stage during the child's life with diverse diagnoses, ranging from acute kidney injury, childhood urinary tract infections (UTIs), electrolyte imbalances and drug-induced nephrotoxicity, to diseases of the glomerulus. The latter include various immune-mediated chronic kidney diseases (CKD) and HIV-associated nephropathy (HIVAN). Discussion The introduction of highly active anti-retroviral therapy (HAART) has dramatically reduced the incidence of HIVAN, once the commonest form of CKD in children of African descent living with HIV, and also altered its prognosis from eventual progression to end-stage kidney disease to one that is compatible with long-term survival. The impact of HAART on the outcome of other forms of kidney diseases seen in this population has not been as impressive. Increasingly important is nephrotoxicity secondary to the prolonged use of anti-retroviral agents, and the occurrence of co-morbid kidney disease unrelated to HIV infection or its treatment. Improved understanding of the molecular pathogenesis and genetics of kidney diseases associated with HIV will result in better screening, prevention and treatment efforts, as HIV specialists and nephrologists coordinate clinical care of these patients. Both haemodialysis (HD) and peritoneal dialysis (PD) are effective as renal replacement therapy in HIV-infected patients with end-stage kidney disease, with PD being preferred in resource-limited settings. Kidney transplantation, once contraindicated in this population, has now become the most effective renal replacement therapy, provided rigorous criteria are met. Given the attendant morbidity and mortality in HIV-infected children and adolescents with kidney disease, routine screening for kidney disease is recommended where resources permit. Conclusions This review focuses on the pathogenesis and genetics, clinical presentation and management of kidney disease in children and adolescents with perinatal HIV-1 infection.
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Dialysis and renal transplantation in HIV-infected patients: a European survey. J Acquir Immune Defic Syndr 2011; 55:582-9. [PMID: 20811290 DOI: 10.1097/qai.0b013e3181efbe59] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. METHODS Cross-sectional multicenter survey of EuroSIDA clinics during 2008. RESULTS Prevalence of ESRD was 0.5%. Of 122 patients with ESRD 96 were on dialysis and 26 had received a RT. Median age was 47 years, 73% were males and 43% were black. Median duration of HIV infection was 11 years. Thirty-three percent had prior AIDS; 91% were receiving antiretrovirals; and 88% had undetectable viral load. Median CD4(+)T-cell count was 341 cells per cubic millimetre; 20.5% had hepatitis C coinfection. Most frequent causes of ESRD were HIV-associated nephropathy (46%) and other glomerulonephritis (28%). Hemodialysis (93%) was the most common dialysis modality; 34% of patients were on the RT waiting list. A poor HIV control was the reason for exclusion from RT waiting list in 22.4% of cases. All the RT recipients were all alive at the time of the survey. Acute rejection was reported in 8 patients (30%). Functioning graft was present in 21 (80%). CONCLUSIONS This is the first multinational cross-sectional study of ESRD among European HIV population. Low prevalence of ESRD was found. Two-thirds of patients were excluded from RT for non-HIV/AIDS-related pathologies. Most patients had a functioning graft despite a high acute rejection rate.
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Novak JE, Szczech LA. Management of HIV-infected patients with ESRD. Adv Chronic Kidney Dis 2010; 17:102-10. [PMID: 20005494 DOI: 10.1053/j.ackd.2009.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/25/2009] [Accepted: 08/25/2009] [Indexed: 11/11/2022]
Abstract
Patients infected with human immunodeficiency virus (HIV) often progress to ESRD. In the era of highly active antiretroviral therapy, the care of these patients has become increasingly complex as survival has improved. Patients infected with HIV who also have ESRD are at risk for critical interactions between medication regimens to treat both of these conditions. Within this population, hemo- and peritoneal dialysis as well as kidney transplantation are life sustaining but present a host of obstacles related to HIV monitoring and risk of transmission, access thrombosis, infection, and rejection. Knowledge of antiretroviral regimens, drug interactions, and HIV resistance as well as the management of ESRD in the presence of HIV infection will improve the care of these unique patients.
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Bansal SB, Singhal M, Ahlawat R, Kher V. Kidney transplantation in a patient with HIV disease. Indian J Nephrol 2009; 19:77-9. [PMID: 20368930 PMCID: PMC2847814 DOI: 10.4103/0971-4065.53328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Human immunodeficiency virus (HIV) disease was considered an absolute contraindication to kidney transplantation until recently. The main reason was the concern regarding the side effects of immunosuppressive drugs in already immunocompromised patients. Kidney transplantation is considered to be the best form of renal replacement therapy in most patients with kidney failure. Nowadays, many world medical centers are successfully doing kidney transplantation in HIV patients with kidney failure. However, HIV disease is still considered a contraindication to kidney transplantation in most Indian centers. Here, we report a case of a patient with HIV infection and ESRD, who underwent successful kidney transplantation in our center.
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Affiliation(s)
- S. B. Bansal
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
| | - M. Singhal
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
| | - R. Ahlawat
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
| | - V. Kher
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
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Trullàs JC, Barril G, Cofan F, Moreno A, Cases A, Fernandez-Lucas M, Martinez-Ara J, Ceballos M, Garcia-de-Diego J, Muñiz ML, Molina J, Martínez-Castelao A, González-Garcia J, Miró JM. Prevalence and clinical characteristics of HIV type 1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006: GESIDA 48/05 study. AIDS Res Hum Retroviruses 2008; 24:1229-35. [PMID: 18834322 DOI: 10.1089/aid.2008.0158] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
End-stage renal diseases (ESRD) are becoming more frequent in HIV-infected patients. In Europe there is little information about HIV-infected patients on dialysis. A cross-sectional multicenter survey in 328 Spanish dialysis units was conducted in 2006. Information from 14,876 patients in dialysis was obtained (81.6% of the Spanish dialysis population). Eighty-one were HIV infected (0.54%; 95% CI, 0.43-0.67), 60 were on hemodialysis, and 21 were on peritoneal dialysis. The mean (range) age was 45 (28-73) years. Seventy-two percent were men and 33% were former drug users. The mean (range) time of HIV infection was 11 (1-27) years and time on dialysis was 4.6 (0.4-25) years. ESRD was due to glomerulonephritis (36%) and diabetes (15%). HIV-associated nephropathy was not reported. Eighty-five percent were on HAART, 76.5% had a CD4 T cell count above 200 cells, and 73% had undetectable viral load. Thirty-nine percent of patients met criteria for inclusion on the renal transplant (RT) waiting list but only 12% were included. Sixty-one percent had HCV coinfection. HCV-coinfected patients had a longer history of HIV, more previous AIDS events, parenteral transmission as the most common risk factor for acquiring HIV infection, and less access to the RT waiting list (p < 0.05). The prevalence of HIV infection in Spanish dialysis units in 2006 was 0.54% HCV coinfection was very frequent (61%) and the percentage of patients included on the Spanish RT waiting list was low (12%).
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Affiliation(s)
- J.-C. Trullàs
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - G. Barril
- Nephrology Service, La Princesa University Hospital, Madrid, Spain
| | - F. Cofan
- Renal Transplant and Nephrology Service, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - A. Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Cases
- Renal Transplant and Nephrology Service, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | | | - J. Martinez-Ara
- Nephrology Service, La Paz University Hospital, Madrid, Spain
| | - M. Ceballos
- Nephrology Service, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - M.-L. Muñiz
- Nephrology Service, Hospital de Cruces, Baracaldo, Spain
| | - J. Molina
- Nephrology Service, Hospital de Donostia, San Sebastian, Spain
| | - A. Martínez-Castelao
- Nephrology Service, Bellvitge University Hospital, Hospitalet del Llobregat, Barcelona, Spain
| | | | - J.-M. Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Schild AF, Perez EA, Gillaspie E, Patel AR, Noicely K, Baltodano N. Use of the Vectra Polyetherurethaneurea Graft for Dialysis Access in HIV-Positive Patients With End-Stage Renal Disease. Vasc Endovascular Surg 2008; 41:506-8. [DOI: 10.1177/1538574407308208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The primary objective of this study was to establish the safety, efficacy, infection rate, and patency of the Vectra graft (polyetherurethaneurea) for dialysis access in patients diagnosed with human immunodeficiency virus (HIV) and end-stage renal disease. The Vectra graft has a unique self-sealing property; therefore we hypothesize that these patients will have fewer infections. A Vectra graft was implanted in 30 consecutive HIV-positive patients without sufficient veins for an autologous fistula. These surgeries were carried out over a 2.5-year period. Primary graft patency was 42% at 12 months and 3 (10%) of the grafts developed infection. This rate of graft infection was less (10% vs 45%) than both our prior experience and published reports using polytetrafluorothene bridge grafts. The unique self-sealing property of the Vectra graft minimizes the development of perigraft hematoma with repetitive needle cannulation and in the immunosuppressed HIV-positive patient, may account for the observed decrease in dialysis access infection.
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Affiliation(s)
- A. Frederick Schild
- Division of Vascular Surgery, University of Miami School of Medicine, Miami, Florida,
| | - Eduardo A. Perez
- Division of Vascular Surgery, University of Miami School of Medicine, Miami, Florida
| | - Erin Gillaspie
- Division of Vascular Surgery, University of Miami School of Medicine, Miami, Florida
| | - Asha R. Patel
- Division of Vascular Surgery, University of Miami School of Medicine, Miami, Florida
| | - Karlene Noicely
- Division of Vascular Surgery, University of Miami School of Medicine, Miami, Florida
| | - Neyton Baltodano
- Division of Vascular Surgery, University of Miami School of Medicine, Miami, Florida
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15
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Soleymanian T, Raman S, Shannaq FN, Richardson R, Jassal SV, Bargman J, Oreopoulos DG. Survival and morbidity of HIV patients on hemodialysis and peritoneal dialysis: one center's experience and review of the literature. Int Urol Nephrol 2007; 38:331-8. [PMID: 16868706 DOI: 10.1007/s11255-006-0080-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Controversy continues concerning the morbidity and mortality of HIV-infected ESRD patients on the two dialysis options. This article presents our experience with complications and survival rate among our HIV-infected ESRD patients on peritoneal dialysis and hemodialysis. We reviewed the literature on this subject. METHODS The charts of seven and eight HIV-infected ESRD patients on peritoneal dialysis and hemodialysis respectively, between January 1989 and November 2004, were reviewed retrospectively for specific clinical and demographic data. Their survival was calculated using the Kaplan-Meier method. RESULTS Total follow-up of HIV-infected PD and HD patients was 248.3 and 207 patient months, respectively. There was no significant difference in hospitalization rate between HIV-infected PD and HD patients (1.01 and 1.39 admission/year, respectively, P = NS). Survival of HIV-infected patients on PD at one, two and three years was 100, 83, and 50%, and for HD patients was 75, 33, and 33%, respectively. HIV-infected patients on HD had more prevalent advanced HIV disease. Two out of seven PD patients were on PD for more than five years and one of the HD patients was on that form of dialysis for more than nine years. Median survival of patients with advanced (Stage IV) AIDS (both HD and PD) was 15.1 months (range 1.6-17.3) while this value for non-advanced (Stage II, III) patients was 61.2 months (range 6.8-116.6). CONCLUSION Type of renal replacement therapy does not have a significant effect on the morbidity and mortality of HIV-infected ESRD patients. Survival is worse in patients with advanced HIV disease. Both dialysis options provide similar results in HIV patients; hence, the choice of dialysis modality should be based on patient's preference and social conditions.
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Affiliation(s)
- Tayebeh Soleymanian
- Nephrology Ward, Shariati Hospital, North Kargar Street, Postal code: 14114, Tehran, Iran.
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16
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Doublier S, Zennaro C, Spatola T, Lupia E, Bottelli A, Deregibus MC, Carraro M, Conaldi PG, Camussi G. HIV-1 Tat reduces nephrin in human podocytes: a potential mechanism for enhanced glomerular permeability in HIV-associated nephropathy. AIDS 2007; 21:423-32. [PMID: 17301560 DOI: 10.1097/qad.0b013e328012c522] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether HIV-1 Tat may directly alter glomerular permeability in HIV-associated nephropathy (HIVAN). DESIGN Heavy proteinuria is a hallmark of HIVAN. The slit diaphragm is the ultimate glomerular filtration barrier critical for maintaining the efficiency of the ultrafiltration unit of the kidney. In this study, we evaluated the direct effect of Tat protein on the permeability of isolated glomeruli and on the expression of nephrin, the main slit diaphragm component, by human cultured podocytes. METHODS Permeability was studied by measuring the permeability to albumin in isolated rat glomeruli. We also evaluated the expression of nephrin in human cultured podocytes by using immunofluorescence and Western blot. RESULTS We found that Tat increased albumin permeability in isolated glomeruli, and rapidly induced the redistribution and loss of nephrin in cultured podocytes. Pretreatment of glomeruli and podocytes with blocking antibodies showed that Tat reduced nephrin expression by engaging vascular endothelial growth factor receptors types 2 and 3 and the integrin alphavbeta3. Pre-incubation of podocytes with two platelet-activating factor (PAF) receptor antagonists prevented the loss and redistribution of nephrin induced by Tat, suggesting that PAF is an intracellular mediator of Tat action. Tat induced a rapid PAF synthesis by podocytes. When podocytes transfected to overexpress PAF-acetylhydrolase, the main catabolic enzyme of PAF, were stimulated with Tat, the redistribution and loss of nephrin was abrogated. CONCLUSION The present results define a mechanism by which Tat may reduce nephrin expression in podocytes, thus increasing glomerular permeability. This provides new insights in the understanding of HIVAN pathogenesis.
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Affiliation(s)
- Sophie Doublier
- Department of Internal Medicine and Center of Experimental Research and Medical Sciences (CERMS), University of Turin, Turin, Italy
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17
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Affiliation(s)
- S Bhagani
- Department of HIV Medicine, Royal Free Hospital, London, UK
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18
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Qiu J, Terasaki PI, Waki K, Cai J, Gjertson DW. HIV-positive renal recipients can achieve survival rates similar to those of HIV-negative patients. Transplantation 2006; 81:1658-61. [PMID: 16794531 DOI: 10.1097/01.tp.0000226074.97314.e0] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although patients positive for HIV were once thought to be unsuitable candidates for kidney transplantation, their increasing numbers with end-stage renal disease (ESRD) and the introduction of highly active antiretroviral therapy has indicated that they should no longer be excluded for transplantation. To counteract suggestions that human immunodeficiency virus (HIV) patients received suboptimal kidneys, we provide studies of kidneys transplanted from the same donor into patients with and without HIV. METHODS United Network for Organ Sharing kidney transplant data between 1997 and 2004 were analyzed. Graft and patient survival of 38 HIV patients who had received a renal transplant were compared with the survival of 38 recipients who had received a graft from the same donor. RESULTS The 38 HIV-positive recipients were younger (49.0 vs. 52.3 years, P=0.14) and had lower peak panel-reactive antibodies (PRA; 5.1% vs. 15.6%, P=0.07) when compared with their bilateral donor to HIV-negative recipients. Sirolimus was used more frequently in HIV patients than in non-HIV patients (36.8% vs. 23.7%, P=0.09). The serum creatinine at 1, 3, and 5 years posttransplantation were higher in HIV patients when compared to non-HIV patients. Although not statistically significant, graft survival was higher among HIV-positive patients compared with their negative controls (76.1% vs. 65.1% at 5 years, P=0.21), as was patient survival (91.3% vs. 87.3% at 5 years, P=0.72). More grafts failed due to death with a functioning graft than rejection in HIV-positive patients. CONCLUSION This study supports the position that there is no longer an ethical question surrounding the use of kidneys for HIV-positive patients.
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Affiliation(s)
- Jianxin Qiu
- Terasaki Foundation Laboratory, Los Angeles, CA 90064, USA.
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19
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Pope SD, Johnson MD, May DB. Pharmacotherapy for human immunodeficiency virus-associated nephropathy. Pharmacotherapy 2006; 25:1761-72. [PMID: 16305296 DOI: 10.1592/phco.2005.25.12.1761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 10% of adult patients with human immunodeficiency virus (HIV) infection have HIV-associated nephropathy (HIVAN). This condition, a leading cause of renal failure, is characterized by damage to specific areas of the renal filtration system. It manifests with increased serum creatinine levels, overt proteinuria, and in some patients, end-stage renal disease (ESRD). The mortality rate for HIVAN-related ESRD is high-30% within the first year of onset. Most instances of HIVAN occur in patients of African descent. Although advances in defining the pathology have been made, the optimal treatment strategy remains unclear. Potential benefits of potent combination antiretroviral therapy, angiotensin-converting enzyme (ACE) inhibitors, and corticosteroids have been reported in small clinical trials and case reports. Cyclosporine is another option, but clinical experience with this agent in managing HIVAN is limited. Few conclusions can be drawn from the limited body of available evidence. Antiretroviral therapy, ACE inhibitors, and corticosteroids are possibly associated with reversal of serum creatinine level increases and proteinuria, but studies are necessary to further define the role of these agents in therapy. Close monitoring is advised when treating any patient with HIVAN.
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Affiliation(s)
- Scott D Pope
- Department of Pharmacy, Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC 28203, and the Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA.
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20
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Behar DM, Shlush LI, Maor C, Lorber M, Skorecki K. Absence of HIV-associated nephropathy in Ethiopians. Am J Kidney Dis 2006; 47:88-94. [PMID: 16377389 DOI: 10.1053/j.ajkd.2005.09.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Accepted: 09/20/2005] [Indexed: 01/14/2023]
Abstract
BACKGROUND Population-based epidemiological surveys in several countries have shown approximately 10- to 15-fold increased susceptibility to human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) for populations of recent African ancestry. Accordingly, we sought to determine whether a similar or different pattern of susceptibility was evident among Ethiopians followed up in an HIV clinic in Israel. METHODS One hundred seventy-six consecutive patients (126 Ethiopians, 50 non-Ethiopian Israelis) followed up at the HIV clinic of Rambam Medical Center in northern Israel were examined for the presence of proteinuria and/or decreased glomerular filtration rate. HIV viral load, CD4 count, and treatment modality also were determined. RESULTS Overall, 73% of patients were treated with highly active antiretroviral therapy, and there was no difference between Ethiopians and non-Ethiopian Israelis in this regard. Mean CD4 count in Ethiopians was 288 +/- 140/microL, significantly less than the corresponding CD4 count of 398 +/- 190/microL for non-Ethiopian Israelis. Mean viral loads were greater in Ethiopians compared with non-Ethiopian Israelis. None of 176 HIV-infected patients fulfilled clinical criteria for HIVAN as delineated in this study. CONCLUSION HIV-infected individuals of Ethiopian descent have a level of susceptibility to HIVAN similar to that of non-Ethiopian Israelis, which is strikingly less than that reported for other populations for recent African ancestry. This does not appear to be attributable to differences in HIV infection control or viral subtype and most likely represents population-based differences in host genetic factors. This finding emphasizes the importance of avoiding generalizations with respect to phylogeographic ancestry in disease-susceptibility studies.
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Affiliation(s)
- Doron M Behar
- Department of Critical Care Medicine, The Bruce Rappaport Faculty of Medicine and Research Institute, Haifa, Israel
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21
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Barril G, Trullás JC, González-Parra E, Moreno A, Bergada E, Jofre R, Martínez-Ara J, de Sequera P, Oliver JA, Arrieta J, Miró JM. Prevalencia de la infección por el VIH en centros de diálisis en España y potenciales candidatos para trasplante renal: resultados de una encuesta española. Enferm Infecc Microbiol Clin 2005; 23:335-9. [PMID: 15970165 DOI: 10.1157/13076172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Patients with HIV infection and end-stage renal disease (ESRD) have improved their survival in the last few years. HIV infection is not considered a contradiction for renal transplantation, but little experience exists in renal transplantation in HIV infected individuals. There is no information about the prevalence of HIV infection in Spanish patients under renal replacement therapies (RRT). METHODS A survey was performed in Spanish dialysis units during 2004. The objective was to study the prevalence and characteristics of HIV infection in patients under RRT in Spain. We also aimed to know how many of them met the Spanish criteria to be included on the renal transplantation waiting list. RESULTS HIV prevalence was 1.15% (95%CI 0.85-1.45) of 4,962 patients who were under RRT, mostly under hemodialysis and, less commonly, peritoneal dialysis. The most frequent risk factor for HIV infection was parenteral drug use (58%). The most common causes of ESRD were glomerulonephritis (44%). The median time under RRT was 46 months. Coinfections with hepatitis C (60%) and B (7%) were found. Thirty-four percent of patients had a history of aids-defining events. Eighty-six percent were under HAART. The median CD4 cell count was 333 cells/.l and the viral load was undetectable in 68%. Of 40 patients with a completed clinical questionnaire, 9 (22.5%) met the Spanish criteria for renal transplantation. CONCLUSION HIV prevalence in patients under RRT in Spain is 1.15% (0.85%-1.45%) and 22.5% percent of these patients met the Spanish criteria to be included on a renal transplantation waiting list.
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Affiliation(s)
- Guillermina Barril
- Servicio de Nefrología, Hospital Universitario La Princesa, Madrid, Spain.
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22
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Trullás JC, Miró JM, Barril G, Ros S, Burgos FJ, Moreno A, Mazuecos A, Alvarez-Vijande R, Oppenheimer F, Carmen Sánchez M, Blanco JL, Tuset M, Torre-Cisneros J, Polo R, González J. Trasplante renal en pacientes infectados por el VIH. Enferm Infecc Microbiol Clin 2005; 23:363-74. [PMID: 15970170 DOI: 10.1157/13076177] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The prevalence of human immunodeficience virus (HIV) infection among patients under renal replacement therapy varies, with estimates of 1% for Europe and 1.5% for the United States. Survival in HIV infected individuals receiving renal replacement therapy has improved since the introduction of high activity antiretroviral therapy (HAART). Current experience in renal transplantation in HIV-infected patients in the United States indicates that the three-year survival rate is similar to that of HIV-negative transplant recipients, with virological and immunological control of the infection by HAART and no increase in the number of opportunistic infections or tumors. The criteria for selecting renal transplantation candidates in this population are the following: no aids-defining events, CD4 cells > 200 cells/.l and undetectable viral load under HAART. In Spain, where most of these patients are former drug abusers, a two-year period of abstinence from cocaine and heroine abuse is also required, although patients can be participating in the methadone program. The main problems in the post-transplantation period have been interactions between HAART and immunosuppressive drugs, management of hepatitis C virus (HCV) coinfection and the high rate of acute rejection. To date, seven such renal transplantations have been performed in Spain, with favorable patient and graft survival and no progression to aids.
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23
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Evidence-based medicine: the dilemma of transplantation in patients with HIV infection. Curr Opin Organ Transplant 2004. [DOI: 10.1097/01.mot.0000142726.14201.8a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ray PE, Xu L, Rakusan T, Liu XH. A 20-year history of childhood HIV-associated nephropathy. Pediatr Nephrol 2004; 19:1075-92. [PMID: 15300477 DOI: 10.1007/s00467-004-1558-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Revised: 05/13/2004] [Accepted: 05/24/2004] [Indexed: 12/16/2022]
Abstract
In 1984, physicians in New York and Miami reported HIV-infected adult patients with heavy proteinuria and rapid progression to end-stage renal disease. These patients showed large edematous kidneys with a combination of focal segmental glomerulosclerosis (FSGS) and tubulointerstitial lesions. This renal syndrome, named HIV-associated nephropathy (HIVAN), was found predominantly in African Americans. Subsequent studies confirmed the presence of HIVAN in children, who frequently develop nephrotic syndrome in association with FSGS and/or mesangial hyperplasia with microcystic tubular dilatation. Since then, substantial progress has been made in our understanding of the etiology and pathogenesis of HIVAN. This article reviews 20 years of research into the pathogenesis of HIVAN and discusses how these concepts could be applied to the treatment of children with HIVAN. HIV-1 infection plays a direct role in the pathogenesis of childhood HIVAN, at least partially by affecting the growth and differentiation of glomerular and tubular epithelial cells and enhancing the renal recruitment of infiltrating mononuclear cells and cytokines. An up-regulation of renal heparan sulfate proteoglycans seems to play a relevant role in this process, by increasing the recruitment of heparin-binding growth factors (i.e., FGF-2), chemokines, HIV-infected cells, and viral proteins (i.e., gp120, Tat). These changes enhance the infectivity of HIV-1 in the kidney and induce injury and proliferation of intrinsic renal cells. Highly active anti-retroviral therapy (HAART) appears to be the most promising treatment to prevent the progression of childhood HIVAN. Hopefully, in the near future, better education, prevention, and treatment programs will lead to the eradication of this fatal childhood disease.
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Affiliation(s)
- Patricio E Ray
- Division of Nephrology, Children's National Medical Center, Washington, DC 20010, USA.
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25
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Mandayam S, Ahuja TS. Dialyzing a patient with human immunodeficiency virus infection: what a nephrologist needs to know. Am J Nephrol 2004; 24:511-21. [PMID: 15452404 DOI: 10.1159/000081041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 08/14/2004] [Indexed: 11/19/2022]
Abstract
The percentage of dialysis centers that have reported dialyzing human immunodeficiency virus (HIV)-infected patients increased from 11% in 1985 to 37% in 2000. Being primary care physicians for the dialysis patients, nephrologists are frequently confronted with the management of HIV-infected dialysis patients especially in urban centers. The aims of the present review are to discuss issues that are unique to HIV infection and end-stage renal disease, and to provide dialysis caretakers with sufficient information to help them optimize care and improve outcomes of these patients. Issues related to the choice of renal replacement therapy, vascular access, management of anemia, vaccination, and antiretroviral therapies are discussed in detail.
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Affiliation(s)
- Sreedhar Mandayam
- Department of Medicine, Division of Nephrology, Galveston, Tex., USA
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Wong KM, Chan YH, Chak WL, Lee MP, Choi KS, Chau KF, Li PCK, Li CS. Continuous Ambulatory Peritoneal Dialysis in a Patient with Human Immunodeficiency Virus Infection. Int J Organ Transplant Med 2004. [DOI: 10.1016/s1561-5413(09)60126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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