Thomas Kagisho L, Davies Malcolm
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Renal Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
South Afr J HIV Med. 2023 May 10;24(1):1471. doi: 10.4102/sajhivmed.v24i1.1471. eCollection 2023.
HIV is a risk factor for the development of chronic kidney disease. People with chronic kidney disease in the state sector are likely to be prescribed continuous ambulatory peritoneal dialysis (CAPD). Previous studies have raised concern about the safety of CAPD in people living with HIV (PLWH) compared to HIV-negative patients.
To compare the risk of peritonitis, and modality and patient survival by HIV status in patients receiving CAPD at Helen Joseph Hospital.
A retrospective study of patients receiving CAPD between 01 January 2007 and 31 December 2017 was undertaken. Five-year patient and modality survival were modelled for PLWH and HIV-negative subgroups and analysed using the log-rank test; the effect of CD4 count, HIV viral load, and duration of antiretroviral therapy on these parameters in PLWH were additionally modelled using the Cox Proportional Hazards technique.
Eighty-four patients, comprising of 21 PLWH and 63 HIV-negative patients, were analysed. No difference was observed in the proportion of patients who had at least one episode of peritonitis between PLWH (61.2%) and HIV-negative patients (63.5%) ( = 0.547). A trend towards increased risk of peritonitis due to Gram-negative organisms in PLWH was noted (odds ratio: 3.20, 95% confidence interval: 0.86-11.9, = 0.083). No difference was observed in 5-year patient or modality survival on CAPD between PLWH (log-rank = 0.161) and HIV-negative patients (log-rank = 0.240).
People living with HIV should not be excluded from CAPD as a mode of kidney replacement therapy (KRT).
HIV是慢性肾脏病发生的一个危险因素。国有部门的慢性肾脏病患者可能会接受持续性非卧床腹膜透析（CAPD）治疗。既往研究对HIV感染者（PLWH）接受CAPD治疗的安全性与HIV阴性患者相比表示担忧。
比较海伦·约瑟夫医院接受CAPD治疗患者中，按HIV感染状态分组的腹膜炎风险、透析方式及患者生存率。
对2007年1月1日至2017年12月31日期间接受CAPD治疗的患者进行回顾性研究。对PLWH和HIV阴性亚组患者进行5年患者及透析方式生存率建模，并采用对数秩检验进行分析；另外，使用Cox比例风险技术对PLWH患者的CD4细胞计数、HIV病毒载量及抗逆转录病毒治疗持续时间对这些参数的影响进行建模。
共分析了84例患者，其中包括21例PLWH和63例HIV阴性患者。PLWH患者（61.2%）和HIV阴性患者（63.5%）中至少发生过一次腹膜炎的患者比例无差异（P = 0.547）。注意到PLWH患者因革兰阴性菌导致腹膜炎的风险有增加趋势（优势比：3.20，95%置信区间：0.86 - 11.9，P = 0.083）。PLWH患者（对数秩P = 0.161）和HIV阴性患者（对数秩P = 0.240）在CAPD治疗中的5年患者或透析方式生存率无差异。
HIV感染者不应被排除在CAPD这一肾脏替代治疗（KRT）模式之外。
