Effect of hemodialysis and antiretroviral therapy on plasma viral load in HIV-1 infected hemodialysis patients

Background: Plasma viral load has become an important test in predicting th e progress of HIV-1 infected patients. The higher the viral load the faster is the progression to AIDS. As HIV-1 infected hemodialysis (HD) patients h ave higher mortality and morbidity than HIV-1 infected non-dialysis patient s, and as all the blood tests in the HD patients are drawn during HD, we me asured the effect of HD and antiretroviral therapy on viral load in HIV-1 i nfected HD patients. Patients and methods: We measured plasma viral load pr e-dialysis and post-dialysis in 10 HIV-1 infected HD patients. The viral lo ad was measured using an in vitro quantitative nucleic acid amplification t est. We also compared viral load in 8 HIV-1 infected HD patients on one ant iretroviral drug with 8 HIV-1 patients on two (6) or three (2) antiretrovir al drugs. Results: There was a small reduction in plasma viral load postdia lysis in all HIV-1 infected HD patients (45% +/- 5.4, 0.3 log +/- 0.05, p < 0.0004). However, HIV-1 RNA could not be detected in the ultrafiltrate. Th e patients who were on two or three antiretroviral drugs had lower viral lo ad (8915 +/- 3702 vs. 351440 +/- 101237, p < 0.004) and higher CD4 count (3 55 +/- 81 vs 82 +/- 39, p < 0.009) than patients on only one antiretroviral drug. Conclusion: We conclude that there is a small reduction in plasma vi ral load in HIV-1 infected hemodialysis patients post-dialysis. As no viral RNA could be detected in the ultrafiltrate, the reduction could be due to nonspecific adsorption of the viral RNA to the dialysis membrane. HIV-1 inf ected hemodialysis patients who are on two or three antiretroviral drugs ha d significantly lower viral load and higher CD4 count than patients on only single antiretroviral drug. Therefore a single antiretroviral drug should not be used in treating HIV-1 infected HD patients.