Improved survival in HIV-infected African-Americans with ESRD

Survival during Renal Replacement Therapy among African Americans Infected with HIV Type 1 in Urban Baltimore, Maryland

“…The authors pointed out that the data were limited by the lack of information regarding HAART use and stage of HIV disease. Similarly, Macrae et al [20], using USRDS data, found that the odds of surviving to 1 year had increased >2-fold among African Americans starting RRT in the HAART era compared with those beginning RRT in the pre-HAART era. In contrast, we found only a marginal increase in 1-year survival after beginning RRT in the HAART era compared with the pre-HAART era (63% vs. 56%).…”

“…Patients who survived to RRT in the pre-HAART era were healthier, with less advanced HIV-1 disease, and therefore their mortality may have been related to their kidney disease rather than HIV-1 infection. If the pre-RRT temporal differences that we observed in HIV-1-related prognostic factors are nationally representative, it implies that analyses of USRDS data [11,20], which lack HIV-1 prognostic factors, might actually be underestimating improvement in survival that has occurred in the HAART era relative to the pre-HAART era.…”

Screening for chronic kidney disease in the ambulatory HIV population

“…The introduction of effective ART was associated with dramatic improvement in survival of patients with end-stage renal disease and HIV infection [9]. Therefore, the IDSA guidelines for chronic kidney disease can be seen as a manifestation of HIV's continued transition from an acute life-threatening illness to a chronic disease process, emphasizing the need for screening and early prevention kidney disease [1].…”

Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected With HIV: 2014 Update by the HIV Medicine Association of the Infectious Diseases Society of America

“…The risk of ESRD in HIV-infected patients is strongly influenced by race, with incidences of 0.9 and 7.3 per 1000 person-years in HIV-infected whites and blacks, respectively [5,45]. Among HIV-infected individuals with ESRD, the introduction of combination ART has been accompanied by improved survival on dialysis [101][102][103][104][105], leading to increased consideration of kidney transplantation in this population [101,106]. CKD also predisposes individuals infected with HIV to acute kidney injury, which occurs at an estimated incidence of between 2.8 and 5.9 cases per 100 person-years [107,108].…”