Evolución clínica de los enfermos renales crónicos en tratamiento sustitutivo con infección por VIH

Ramón Saracho, Eduardo Martín Escobar, Jordi Comas Farnés, Emma Arcos, Auxiliadora Mazuecos Blanca, Miguel Ángel Gentil Govantes, Pablo Castro de la Nuez, Óscar Zurriaga, Manuel Ferrer Alamar, Encarnación Bouzas Caamaño, Teresa García Falcón, José Portolés Pérez, José A. Herrero Calvo, Carlos Chamorro Jambrina, Íñigo Moina Eguren, María Teresa Rodrigo de Tomás, José María Abad Díez, José I. Sánchez Miret, Rafael Alvarez Lipe, Rafael Díaz Tejeiro, Inmaculada Moreno Alía, Marta Torres Guinea, Enma Huarte Loza, Marta Artamendi Larrañaga, Carlos Fernández Renedo, Raquel González Fernández, Emilio Sánchez Álvarez, Ramón Alonso de la Torre

Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.