RENAL REPLACEMENT THERAPY IN HIV-POSITIVE PATIENTS

Background: The clinical course of 17 uremic immunodeficiency virus (H IV) type I seropositive patients were analyzed to further define indic ation, complications and outcome of chronic renal replacement therapy (RRT) and acute RRT in HIV-positive patients. Methods: Clinical data f rom 7 HIV-positive males (CDC stage I n = 2, CDC stage II n = 2, CDC s tage III n = 3) on chronic RRT, and from 10 patients (9 male, 1 female , all CDC stage III) on acute RRT were evaluated. All but one patient who received plasmapheresis (PPh) were treated with bicarbonate hemofi ltration, using conventional vascular access. Results. RRT-related com plications were anemia requiring blood transfusions in all patients an d thrombosis of the a.v. fistula in 3 patients. Opportunistic infectio ns included pneumocystis carinii pneumonia (PCP), cytomegaly virus inf ection, herpes tester virus infection, varicella tester virus infectio n, mycobacterium avium intracellular infection, and toxoplasmosis. Ant iretroviral substances were given in 9 patients with CD4(+) lymphocyte counts below 350/mu l, PCP-prophylaxis was performed in patients with absolute CD4+ lymphocyte counts below 200/mu l. A decline of the CD4/ CD8-ratio was noted in all patients. Two of the 7 patients under chron ic RRT are still alive. Two patients died due to renal complications. One-year survival time was 86% for patients under chronic RRT. Eight o f the 10 patients treated with acute RRT suffered from additional seve re diseases and died within one month, 1 patient survived more than 2 years. Conclusions: We conclude that RRT provides a substantial benefi t for stable and compliant HIV-patients, though acute RRT in advanced stages of the disease does not seem to substantially improve the clini cal outcome. The overall prognosis of uremic HIV-patients is poor comp ared with other groups of patients with end-stage renal failure.