학술논문
Enfermedad Renal Crónica y Terapia Renal Sustitutiva en Pacientes con Infección por el Virus de la Inmunodeficiencia Humana: Prevalencia y Supervivencia en Terapia Renal Sustitutiva (Diálisis y Trasplante Renal)
Document Type
Dissertation/Thesis
Author
Source
TDX (Tesis Doctorals en Xarxa)
Subject
Language
Spanish; Castilian
Abstract
BACKGROUND: Antiretroviral therapy (ART) has been immensely successful in reducing AIDS-events and death after HIV infection, raising the interest in non-infectious comorbidities including kidney disease. There is a lack of clinical and epidemiological data regarding kidney issues in HIV-infected patients. OBJECTIVE: to improve global knowledge on kidney diseases in HIV-infected patients, focusing on clinical and epidemiological issues (prevalence, survival and prognostic factors) among HIV infection on dialysis or renal transplantation (RT) in Spain and Europe. METHODS: the following studies were conducted: three cross-sectional prevalence studies, one retrospective survival cohort study and two descriptive case series experiences. RESULTS AND CONCLUSIONS: the results are included in 6 original and 3 related studies with the following conclusions: 1.- Prevalence of HIV on dialysis units in Spain was 0.54% being higher on peritoneal dialysis. 2.- Spanish HIV-infected patients on dialysis were young males, with no-HIVAN glomerulonephritis and with a good control of HIV. In European patients a higher proportion of black race and HIVAN was found. 3.- 39.5% of HIV-infected patients on dialysis met criteria to be included on RT waiting list. Only 12% were already included. The most frequent exclusion criteria were related with poor control of HIV. 4.- HCV coinfection was present in 2/3 of HIV-infected patients on dialysis, was not associated with mortality but with lower access to RT. 5.- Survival of HIV-infected patients on dialysis was lower than that of matched HIV-negative patients. Factors related with poor prognosis were the absence of ART and peritoneal dialysis. 6.- Patients and graft survival rates of European HIV-infected RT recipients were similar to HIV-negative patients. Acute rejection was more frequent (30%). 7.- Thymoglobulin produced a profound lymphocytopenia that was not associated with increased risk of infections. 8.- Raltegravir had no interactions with immunosuppressants and can be used safely after transplant.