Race Modifies HIV’s Impact on Dialysis Survival

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Even with modern antiretroviral therapy (ART), survival on dialysis is significantly lower for non-white patients with HIV infection, according to a study in Kidney International.

Using data from a nationwide dialysis provider, the researchers identified two groups of HIV-positive dialysis patients: 5348 patients who had HIV only and 1863 patients with HIV and hepatitis C virus (HCV) coinfection. In both groups, a large majority of patients were African American: 74.3% of the HIV-positive group and 81.6% of the HIV/HCV-positive group. Percentages of Caucasian patients were 13.2% and 9.0%, respectively.

A cohort of 410,545 HIV/HCV-negative patients were studied for comparison: 47.6% Caucasian and 29.0% African American. The effects of HIV- and HIV/HCV-positive status on mortality were assessed, along with the possible modifying effects of race.

In Caucasians, HIV status was not significantly related to mortality, but HIV/HCV infection was: hazard ratio (HR) 1.48. For non-Caucasians, both HIV- and HIV/HCV-positive status were associated with higher mortality: HR 1.44 and 1.77, respectively. The results were similar in secondary analyses using matched propensity scores.

The effects of HIV infection on dialysis outcomes are unclear, particularly in the era of widespread ART use. The new analysis suggests a “very concerning” reduction in survival associated with HIV-positive status in non-Caucasian patients: African American, Latino, Asian, and “other.”

Across racial/ethnic group, dialysis survival is reduced for patients with HIV/HCV coinfection. The authors discuss the need for interventions targeting these vulnerable populations, possibly including early nephrology referral and therapy for HCV [Sawinski D, et al. Race but not hepatitis C co-infection affects survival of HIV+ individuals on dialysis in contemporary practice. Kidney Int 2017; http://dx.doi.org/10.1016/j.kint.2017.08.015].