在 cART 时代接受透析的 HIV-1 感染患者的结局和预后因素：一项 GESIDA/SEN 队列研究。
Outcome and prognostic factors in HIV-1-infected patients on dialysis in the cART era: a GESIDA/SEN cohort study.
机构信息
Hospital Sant Jaume de Olot University of Girona, Girona, Spain.
出版信息
J Acquir Immune Defic Syndr. 2011 Aug 1;57(4):276-83. doi: 10.1097/QAI.0b013e318221fbda.
BACKGROUND
Prognosis of HIV-infected patients on dialysis has improved. Few studies have compared survival between HIV-infected and HIV-negative patients on dialysis in the combined antiretroviral therapy (cART) era. We compared the outcome of HIV-infected patients on dialysis with a matched HIV-negative cohort.
METHODS
National, multicenter, retrospective cohort study of HIV-infected patients starting dialysis in Spain (1999-2006). Matching criteria for HIV-negative patients were dialysis center, year of starting dialysis, age, sex, and race.
RESULTS
The study population comprised 122 patients, 66 HIV-infected, and 66 HIV-negative patients. Median age was 41 years, and all but 4 HIV-infected patients were white. HIV-associated nephropathy was only present in 4 cases. HIV-infected patients were less frequently included on the kidney transplantation waiting list (17% vs 62%, P < 0.001). They also had more hepatitis C virus coinfection (76% vs 11%, P < 0.001), fewer cardiovascular events (62% vs 88%, P = 0.001), fewer kidney transplants (4.5% vs 38%, P < 0.001), and higher mortality (32% vs 1.5%, P < 0.001). Survival rates [95% confidence interval (CI)] at 1, 3, and 5 years for HIV-infected patients were 95.2% (89.9%-100%), 71.7% (59.7%-83.7%), and 62.7% (46.6%-78.8%). Five-year survival for HIV-negative patients was 94.4% (83.8%-100%) (P < 0.001). Multivariate analysis revealed the following variables to be associated with death in HIV-infected patients: peritoneal dialysis vs hemodialysis [hazard ratio; (95% CI): 2.88 (1.16-7.17)] and being on effective cART [hazard ratio (95% CI): 0.39 (0.16-0.97)].
CONCLUSIONS
Medium-term survival of HIV-infected patients on dialysis was lower than that of matched HIV-negative patients. Fewer HIV-infected patients had access to kidney transplantation. Being on effective cART improves survival. Further studies are needed to determine whether peritoneal dialysis increases mortality.
背景
接受透析治疗的 HIV 感染者的预后已得到改善。在联合抗逆转录病毒治疗（cART）时代，很少有研究比较 HIV 感染者和 HIV 阴性透析患者的生存情况。我们比较了接受透析治疗的 HIV 感染者与匹配的 HIV 阴性队列的结果。
方法
这是一项全国性、多中心、回顾性队列研究，纳入了西班牙于 1999 年至 2006 年期间开始透析的 HIV 感染者。对 HIV 阴性患者进行匹配的标准为透析中心、开始透析的年份、年龄、性别和种族。
结果
研究人群包括 122 名患者，其中 66 名 HIV 感染者和 66 名 HIV 阴性患者。中位年龄为 41 岁，除 4 名外，所有 HIV 感染者均为白人。仅 4 例存在 HIV 相关性肾病。HIV 感染者较少被列入肾脏移植等候名单（17% vs 62%，P < 0.001）。他们也更常合并丙型肝炎病毒感染（76% vs 11%，P < 0.001），较少发生心血管事件（62% vs 88%，P = 0.001），较少接受肾脏移植（4.5% vs 38%，P < 0.001），死亡率更高（32% vs 1.5%，P < 0.001）。HIV 感染者的 1、3 和 5 年生存率[95%置信区间（CI）]分别为 95.2%（89.9%-100%）、71.7%（59.7%-83.7%）和 62.7%（46.6%-78.8%）。HIV 阴性患者的 5 年生存率为 94.4%（83.8%-100%）（P < 0.001）。多变量分析显示，以下变量与 HIV 感染者死亡相关：腹膜透析与血液透析[风险比；（95%CI）：2.88（1.16-7.17）]和接受有效的 cART[风险比（95%CI）：0.39（0.16-0.97）]。
结论
接受透析治疗的 HIV 感染者的中期生存率低于匹配的 HIV 阴性患者。较少的 HIV 感染者能够接受肾脏移植。接受有效的 cART 可提高生存率。需要进一步研究以确定腹膜透析是否会增加死亡率。
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