Outcomes of Dialysis Patients Living With HIV in Australia and New Zealand: A Cohort Study Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)

Overview

Aim:

To describe the demographics and comorbidities of people living with HIV (PLWH) starting on dialysis in Australia and New Zealand and to assess mortality outcomes and rates of infective complications.

Methods:

Retrospective population-based cohort study of between 1996 and 2022. The primary outcome was the difference in survival between PLWH and HIV-negative patients started on dialysis. Other outcomes included peritoneal dialysis peritonitis rates and causative organisms.

Results:

A total of 82 739 patients were included in the study; 95 (0.1%) were HIV-positive. The median age at first dialysis was lower in the PLWH group at 53 years (IQR 44-60) compared to 61 years (IQR 49-71) in the HIV-negative group (p < 0.001). PLWH had higher rates of tubulointerstitial disease (15% vs. 10%) and glomerular disease (29% vs. 23%) than the HIV-negative cohort (p = 0.030). There were similar patterns of other comorbidities. Median survival from commencement of dialysis was similar between PLWH and HIV-negative patients at 7.1 years (95% CI 6.1-10.3 years) and 6.3 years (95% CI 6.2-6.4), respectively, (p = 0.34); the younger age at commencement for PLWH meant that median lifespan was approximately 7 years shorter. Causes of death were similar between groups, with cardiovascular death being most common at 43%, followed by withdrawal at 24% and then infection at 17% (p = 0.64). There was no clinically significant difference in peritonitis rates or causative organisms.

Conclusion:

PLWH had a shorter median lifespan as compared to HIV-negative patients on dialysis; however, this was entirely a consequence of earlier renal failure in PLWH, with on-dialysis mortality similar between the two groups.