From the Journals

HIV+ dialysis patients: Differential survival by race compared with HIV/HCV coinfection


Key clinical point: Race is significantly associated with mortality in HIV-infected dialysis patients.

Major finding: HIV infection is associated with a significant reduction in dialysis survival for nonwhites; HIV/HCV coinfection is associated with impaired survival regardless of race/ethnicity.

Study details: Survival on dialysis of 5,348 HIV-infected individuals and 1,863 HIV/HCV coinfected individuals was retrospectively compared with an HIV/HCV reference cohort.

Disclosures: One author consulted on a project related to hyperkalemia and hyperphosphatemia in dialysis patients, and has grant funding from Merck in support of treating hepatitis C after kidney transplantation. The other authors had no disclosures.

Source: Sawinski et al. Kidney Int. 2018;93(3):706-15.



Race, but not coinfection with hepatitis C virus, differentially affects survival of HIV-positive patients who have end-stage renal disease, according to a study published in Kidney International.

Nonwhites fared significantly worse in survival than did the white cohort when both groups were infected with HIV alone, but the two groups fared similarly badly when coinfected with HIV and HCV, according to Deirdre L. Sawinski, MD, assistant professor at the University of Pennsylvania, Philadelphia, and assistant medical director, Penn Kidney Pancreas Transplant Program, and her colleagues.

Arm of a patient on dialysis ©picsfive/Fotolia
The investigators retrospectively assessed 410,545 HIV-negative/HCV-negative individuals as reference controls and compared them with 5,348 HIV+ and 1,863 HIV+/HCV+ coinfected individuals from 2,858 dialysis facilities in 47 states, using a database from one of the largest dialysis providers in the country.

They found that HIV infection was not associated with a higher risk of death in white patients (hazard ratio, 1.03), in contrast to HIV/HCV coinfection, which was significantly associated with a higher mortality (HR, 1.48). However, in the nonwhite patients, HIV infection (HR, 1.44) and HIV/HCV coinfection (HR, 1.71) were both significantly associated with increased mortality.

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