Acceptance situation of HIV patients in Japanese dialysis facilities—questionnaire survey by the Infection Survey Subcommittee

Abstract

Background: A newspaper article in August 2016 reported that about 40 medical facilities refused dialysis to a human immunodeficiency virus (HIV) patient. Infection Survey Subcommittee in the Japanese Society for Dialysis Therapy investigated this situation. Methods: An anonymous questionnaire survey about the acceptance of HIV-positive patients was sent to 4039 dialysis institutions. The questionnaire included a number of HIV-positive patients on dialysis currently and in the last 5 years, details on whether the institution received requests to perform dialysis on HIV-positive patients, the responses to these requests, the preparation system for acceptance, the reasons for refusal of dialysis of HIV-positive patients, knowledge of HIV-related guidelines in use, and the considerations for the acceptance of dialysis for HIV-positive patients. We evaluated answers to these questions from the institutions. Results: Two thousand five hundred eighty-three facilities (64.0%) responded to the survey questions. In the past 5 years, 215 facilities (8.3%) were requested to accept HIV patients for dialysis and 40.1% of these refused acceptance. Although manuals, written policy and procedure, for a needle piercing accident existed in most of the facilities that accepted the patients, many facilities did neither prepare the stocks of anti-HIV drugs nor cooperate with HIV core hospitals. Principal reasons for the refusal were listed as the lack of medical experience with HIV patients, anxiety of healthcare providers with regard to HIV infection risk, lack of stocks of anti-HIV drugs for needle piercing accidents, and the lack of cooperation with HIV core hospitals. The proportion of facilities expected to accept HIV patients in the future was as low as 16.9% among all facilities that responded to the survey. Conclusions: The Japanese Society for Dialysis Therapy will need to strengthen the cooperation with other academic societies and disseminate basic knowledge on HIV and infection control measures to develop and establish the acceptance system of maintenance dialysis for HIV patients.

A high likelihood of increase in end-stage renal disease among the Japanese HIV-infected population

“…Some needs remain unmet in terms of acceptance of HIV-infected hemodialysis patients by general dialysis clinics in Japan. According to the latest report by the Infection Survey Subcommittee, Japanese Society for Dialysis Therapy [62], the cooperation system for treatment of HIV-infected patients at general hemodialysis clinics is inadequate. In the questionnaire survey of 4039 institutions, 215 of the 2583 institutions that responded to the survey (response rate, 64%) were requested to accept HIV-infected patients, and 87 of 215 (40%) refused the request.…”

“…An increase in the number of HIV-positive ESRD patients is actual, and cooperation of general dialysis clinics in their acceptance has become necessary [52,53,62,63]. It is Fig.…”