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Barriers to kidney transplant evaluation in HIV-positive patients with advanced kidney disease: A single-center study
Journal article   Open access   Peer reviewed

Barriers to kidney transplant evaluation in HIV-positive patients with advanced kidney disease: A single-center study

Suzanne M Boyle, Kallie Fehr, Catylin Deering, Abbas Raza, Meera N Harhay, Gregory Malat, Karthik Ranganna and Dong Heun Lee
Transplant infectious disease, v 22(2), pp e13253-n/a
Apr 2020
DOI: https://doi.org/10.1111/tid.13253
PMID: 31994821
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162707View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Adult Anti-Retroviral Agents - therapeutic use CD4 Lymphocyte Count Electronic Health Records Eligibility Determination Female Glomerular Filtration Rate HIV Infections - complications HIV Infections - drug therapy Humans Kidney Diseases - complications Kidney Diseases - virology Kidney Transplantation - adverse effects Kidney Transplantation - standards Male Middle Aged Retrospective Studies Viral Load
HIV-positive kidney transplant (KT) recipients have similar outcomes to HIV-negative recipients. However, HIV-positive patients with advanced kidney disease might face additional barriers to initiating the KT evaluation process. We sought to characterize comorbidities, viral control and management, viral resistance, and KT evaluation appointment rates in a cohort of KT evaluation-eligible HIV-positive patients. We included patients seen between January 1, 2008, and December 31, 2015, at a primary care HIV clinic who met KT evaluation eligibility by an estimated glomerular filtration rate ≤20 mL/min/1.73 meters or dialysis dependence. The primary outcome was a documented appointment for KT evaluation. Of 3735 patients evaluated at the HIV primary clinic during the study period, 42 (1.6%) were KT evaluation-eligible patients. The median age was 47 years, 77% were male, and 95%, black. Median CD4 count was 328 cells/mm (IQR 175-461). Among the 63% percent with antiretroviral therapy (ART) prescription, 40% had viral loads >200 copies. Among patients with HIV resistance profiles (50%, n = 21), 52% had resistance to at least one class of ART. A majority (60%, n = 25) were scheduled for KT evaluation appointment, but of those, only 8% (n = 2) had evidence of appointments before dialysis dependence. Those without appointments had more schizophrenia (29% vs 4%, P = .02), resistance (78% vs 33%, P = .04), ART prescription (76% vs 48%, P = .04), and more kidney disease of unknown etiology (53% vs 8%, P = .02). Kidney transplant evaluation-eligible HIV-positive patients had a high rate of evaluation appointments, but a low rate of preemptive evaluation appointments. Schizophrenia and viral resistance disproportionally affected patients without evaluation appointments. These data precede the recommendation for universal ART for all HIV+ patients, regardless of CD4 count and viral load, and must be interpreted in the context of this limitation.

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Immunology
Infectious Diseases
Transplantation
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