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Evolución de los pacientes infectados por el VIH en diálisis peritoneal: experiencia de un centro y revisión de la literatura [Outcome of HIV-infected patients of peritoneal dialysis: experience in a center and literature review]
Overall survival of HIV-infected has increased over the last ten years. In parallel a higher need for renal replacement therapy (RRT) in this population has been more observed. RRT associated complications and outcomes greatly varied since the introduction of highly active antiretroviral therapy (HAART) and scarce data is available regarding the outcome of peritoneal dialysis (PD) in HIV-infected patients under HAART. We described 8 HIV-infected patients who were admitted at the Peritoneal Dialysis Unit at our institution from November-95 to November-07. Mean age was 40.7 +/- 5.3. Causes of end-stage renal disease were diabetes mellitus type 1 (2), focal and segmental glomerular sclerosis (2), IgA nephropathy (1) and unknown origin (3). High blood pressure was detected in 62,5% of the patients. Mean follow-up was 41.2 +/- 32.1 months (range 12-103). One, two and three year survival was 100, 62.5 and 50% respectively. Overall mortality was 62.5% and cardio-vascular events were the main cause of death (2 patients, 25%). Infective peritonitis rate was 0.36 IP/year, and Staphylococcus epidermidis was the most common pathogen identified. Hospital admission rate was 0.69 admission/year and the main cause of admission was respiratory tract infection. All patients received HAART. Lamivudine, stavudine and nelfinavir were the most frequent treatment prescribed. During the first year in PD undetectable viral load and CD4 % were not modified. A significant weight gain was observed during the first year of the study (60.6 kg. vs 64.9 kg. p > or = 0.016). Our results suggest that PD is a suitable choice for RRT in HIV-infected. Compared to previous studies, an increase in overall survival and a decrease in PD-associated complications were seen. The significance of cardio-vascular risk factors in the outcome of PD in HIV-infected patients is not completely determined. A multidisciplinary approach and a management of patients in individual basis remains mandatory.
Adult, Female, HIV Infections, Humans, Male, Middle Aged, Peritoneal Dialysis, Survival Rate
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