Outcomes of Dialysis Patients Living With HIV in Australia and New Zealand: A Cohort Study Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).

AIM

To describe the demographics and comorbidities of people living with HIV (PLWH) starting on dialysis in Australia and New Zealand and to assess mortality outcomes and rates of infective complications.

METHODS

Retrospective population-based cohort study of between 1996 and 2022. The primary outcome was the difference in survival between PLWH and HIV-negative patients started on dialysis. Other outcomes included peritoneal dialysis peritonitis rates and causative organisms.

RESULTS

A total of 82 739 patients were included in the study; 95 (0.1%) were HIV-positive. The median age at first dialysis was lower in the PLWH group at 53 years (IQR 44-60) compared to 61 years (IQR 49-71) in the HIV-negative group (p < 0.001). PLWH had higher rates of tubulointerstitial disease (15% vs. 10%) and glomerular disease (29% vs. 23%) than the HIV-negative cohort (p = 0.030). There were similar patterns of other comorbidities. Median survival from commencement of dialysis was similar between PLWH and HIV-negative patients at 7.1 years (95% CI 6.1-10.3 years) and 6.3 years (95% CI 6.2-6.4), respectively, (p = 0.34); the younger age at commencement for PLWH meant that median lifespan was approximately 7 years shorter. Causes of death were similar between groups, with cardiovascular death being most common at 43%, followed by withdrawal at 24% and then infection at 17% (p = 0.64). There was no clinically significant difference in peritonitis rates or causative organisms.

CONCLUSION

PLWH had a shorter median lifespan as compared to HIV-negative patients on dialysis; however, this was entirely a consequence of earlier renal failure in PLWH, with on-dialysis mortality similar between the two groups.