Renal Transplantation in HIV-positive and HIV-negative People With Advanced Stages of Kidney Disease: Equity in Transplantation

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2024 May 13

PMID 38737424

Authors

Seyed M Hosseini-Moghaddam

Yuguang Kang

Sarah E Bota

Matthew A Weir

Affiliations

Soon will be listed here.

Abstract

Background: People with HIV are at a greater risk of end-stage kidney disease than the general population. Considering the risk of death after end-stage kidney disease, access to renal transplantation in people with HIV is critically important.

Methods: We included all adult patients on chronic dialysis in Ontario, Canada, between 1 April 2007 and 31 December 2020. We determined the probability of kidney transplantation with competing risk of death over time since the initiation of dialysis by calculating the adjusted subdistribution hazard ratios (sdHR; 95% confidence interval [CI]). We also compared long-term renal allograft and posttransplant mortality outcomes between HIV-negative and HIV-positive persons.

Results: Of 40 686 people (median age, 68 years; interquartile range, 57-77; 38.4% women), 173 were HIV-positive and 40 513 were HIV-negative. The incidence of kidney transplantation in HIV-negative and HIV-positive patients was 40.5 (95% CI, 39.4-41.6)/1000 person-years and 35.0 (95% CI, 22.8-53.7)/1000 person-years, respectively ( = .51). Considering the competing risk of death, HIV-positive people had a significantly lower chance of receiving kidney transplants than HIV-negative people (sdHR, 0.46 [95% CI, .30-.70]). The long-term allograft failure risk was not significantly different between HIV-negative and HIV-positive people, considering the competing risk of posttransplant death (sdHR, 1.71 [95% CI, .46-6.35]).

Conclusions: Although the incidence and crude probability of kidney transplantation were similar among HIV-negative and HIV-positive persons in this cohort, those with HIV had a significantly lower likelihood of kidney transplantation than those without HIV. Having HIV was not significantly associated with a poor long-term allograft outcome compared with patients without HIV.

References

Ekrikpo U, Kengne A, Bello A, Effa E, Noubiap J, Salako B . Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis. PLoS One. 2018; 13(4):e0195443. PMC: 5901989. DOI: 10.1371/journal.pone.0195443. View

Szczech L, Gange S, van der Horst C, Bartlett J, Young M, Cohen M . Predictors of proteinuria and renal failure among women with HIV infection. Kidney Int. 2002; 61(1):195-202. DOI: 10.1046/j.1523-1755.2002.00094.x. View

Abraham A, Althoff K, Jing Y, Estrella M, Kitahata M, Wester C . End-stage renal disease among HIV-infected adults in North America. Clin Infect Dis. 2014; 60(6):941-9. PMC: 4357817. DOI: 10.1093/cid/ciu919. View

Tourret J, Guiguet M, Lassalle M, Grabar S, Lievre L, Isnard-Bagnis C . Access to the waiting list and to kidney transplantation for people living with HIV: A national registry study. Am J Transplant. 2019; 19(12):3345-3355. DOI: 10.1111/ajt.15500. View

Zarinsefat A, Gulati A, Shui A, Braun H, Rogers R, Hirose R . Long-term Outcomes Following Kidney and Liver Transplant in Recipients With HIV. JAMA Surg. 2022; 157(3):240-247. PMC: 8733865. DOI: 10.1001/jamasurg.2021.6798. View

Locke J, Mehta S, Sawinski D, Gustafson S, Shelton B, Reed R . Access to Kidney Transplantation among HIV-Infected Waitlist Candidates. Clin J Am Soc Nephrol. 2017; 12(3):467-475. PMC: 5338712. DOI: 10.2215/CJN.07460716. View

Austin S, Wong Y, Uzzo R, Beck J, Egleston B . Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2013; 53(9):e65-72. PMC: 3818341. DOI: 10.1097/MLR.0b013e318297429c. View

Swanson S, Kirk A, Ko C, Jones C, Agodoa L, Abbott K . Impact of HIV seropositivity on graft and patient survival after cadaveric renal transplantation in the United States in the pre highly active antiretroviral therapy (HAART) era: an historical cohort analysis of the United States Renal Data System. Transpl Infect Dis. 2002; 4(3):144-7. DOI: 10.1034/j.1399-3062.2002.01009.x. View

Muller E, Botha F, Barday Z, Manning K, Chin-Hong P, Stock P . Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies. Transplantation. 2020; 105(7):1492-1501. PMC: 8026768. DOI: 10.1097/TP.0000000000003485. View

10.

Wang C, Naylor K, Luo B, Bota S, Dixon S, Yohanna S . Using Administrative Health Care Databases to Identify Patients With End-Stage Kidney Disease With No Recorded Contraindication to Receiving a Kidney Transplant. Can J Kidney Health Dis. 2022; 9:20543581221111712. PMC: 9309776. DOI: 10.1177/20543581221111712. View

11.

Roland M, Barin B, Huprikar S, Murphy B, Hanto D, Blumberg E . Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls. AIDS. 2016; 30(3):435-44. PMC: 4957135. DOI: 10.1097/QAD.0000000000000934. View

12.

Blake P . Global Dialysis Perspective: Canada. Kidney360. 2022; 1(2):115-118. PMC: 8809102. DOI: 10.34067/KID.0000462019. View

13.

Antoniou T, Zagorski B, Loutfy M, Strike C, Glazier R . Validation of case-finding algorithms derived from administrative data for identifying adults living with human immunodeficiency virus infection. PLoS One. 2011; 6(6):e21748. PMC: 3128093. DOI: 10.1371/journal.pone.0021748. View

14.

Sawinski D, Forde K, Eddinger K, Troxel A, Blumberg E, Tebas P . Superior outcomes in HIV-positive kidney transplant patients compared with HCV-infected or HIV/HCV-coinfected recipients. Kidney Int. 2015; 88(2):341-9. PMC: 5113138. DOI: 10.1038/ki.2015.74. View

15.

Ahuja T, Grady J, Khan S . Changing trends in the survival of dialysis patients with human immunodeficiency virus in the United States. J Am Soc Nephrol. 2002; 13(7):1889-93. DOI: 10.1097/01.asn.0000019773.43765.bf. View

16.

Locke J, Gustafson S, Mehta S, Reed R, Shelton B, Maclennan P . Survival Benefit of Kidney Transplantation in HIV-infected Patients. Ann Surg. 2016; 265(3):604-608. PMC: 5285482. DOI: 10.1097/SLA.0000000000001761. View

17.

Benchimol E, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I . The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015; 12(10):e1001885. PMC: 4595218. DOI: 10.1371/journal.pmed.1001885. View

18.

Rasch M, Helleberg M, Feldt-Rasmussen B, Kronborg G, Larsen C, Pedersen C . Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population. Nephrol Dial Transplant. 2013; 29(6):1232-8. DOI: 10.1093/ndt/gft289. View

19.

Adnani H, Agrawal N, Khatri A, Vialet J, Zhang M, Cervia J . Impact of Antiretroviral Therapy on Kidney Disease in HIV Infected Individuals - A Qualitative Systematic Review. J Int Assoc Provid AIDS Care. 2022; 21:23259582221089194. PMC: 8984856. DOI: 10.1177/23259582221089194. View

20.

Matlosz B, Skrzat-Klapaczynska A, Antoniak S, Balayan T, Begovac J, Dragovic G . Chronic Kidney Disease and Nephrology Care in People Living with HIV in Central/Eastern Europe and Neighbouring Countries-Cross-Sectional Analysis from the ECEE Network. Int J Environ Res Public Health. 2022; 19(19). PMC: 9565150. DOI: 10.3390/ijerph191912554. View