HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) INFECT ION IN PATIENTS ON MAINTENANCE DIALYSIS

Nine patients with HIV infection have been on maintenance dialysis (D) , between June 1987 and October 1992, in the << Gregorio Maranon >> Ho spital in Madrid. In five of them, HN antibodies (Ah) were detected in lune 1987, at first tim we tested, for HIVAb, all patients on D and w ith a functioning kidney allograft. Since 1987, only four patients, HI V seropositive before they developed renal insufficiency, were include d into D programme. Access to dialysis treatment has not been limited for these patients. Proportion between HIV+/HIV- patients, who began D during last four years was 1,14%. The prevalence of HIV seropositive patients on Dialysis has decreased from 2,1% in 1987 to 0,34% in 1992; the high mortality rate of these patients, 63% annual; explain that d ecrease. All patients, except the last one, died during follow-up; sev en out of 9 developed Acquired Immunodeficiency Syndrome (AIDS). Ab sc reening for HIV infection by standard ELISA sometimes yields false pos itive results in patients with renal failure, therefore it is especial ly important to confirm HIV+ with Western-Blot test. Initially, we ind icate Continous Ambulatory Peritoneal Dialysis (CAPD) as first choice renal replacement therapy for end-stage renal disease in these patient s; 2 of them underwent on CAPD, but they developed complications, that obligated to change to Hemodialysis. The relative benefits of C4PD th erapy described initially, are contrabalanced by frequent social and m edical complications of that technique. The possibility of nosocomial transmission appears unlikely when routine precautions are followed. P atients with clinical HIV infection have been considered contraindicat ions to transplantation.