Arteriovenous access outcomes in haemodialysis patients with HIV infection

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Abstract

Background

Arteriovenous (AV) grafts in haemodialysis patients usually fail due to thrombosis or infection. There is limited information on whether graft outcomes in HIV-positive haemodialysis patients differ from those in HIV-negative controls.

Methods

Using a prospective, computerized vascular access database, we identified retrospectively 15 HIV-positive dialysis patients having a graft placed during a 6.5-year period (January 1999 to June 2005), and compared their graft outcomes to those observed in 30 age-, sex- and access date-matched HIV-negative control patients. In addition, the outcomes of AV fistulas in 23 HIV-positive patients were compared with those observed in 32 matched HIV-negative controls.

Results

Thrombosis-free graft survival was substantially worse among the HIV-positive patients than in the HIV-negative controls (1-year survival, 17% vs 62%). The hazard ratio for graft thrombosis in the HIV-positive patients was 3.22 (95% CI, 1.66–10.32, P=0.002). Infection-free graft survival was also lower in HIV-positive patients (hazard ratio 3.51; 95% CI, 1.21–18.85, P=0.025). Finally, cumulative graft survival (from creation until permanent failure) tended to be lower in HIV-positive patients (1 year survival, 41% vs 65%, P=0.07). The primary failure rate of fistulas (those never usable for dialysis) was similar in HIV-positive patients and in their controls (44% vs 41%, P=0.83). Cumulative fistula survival was similar for HIV-positive and negative patients (hazard ratio 1.32; 95% CI, 0.65–3.58, P=0.33).

Conclusion

AV grafts have inferior outcomes in HIV-positive patients as compared with HIV-negative patients, whereas fistulas have a similar survival in both groups.

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