ABSTRACT
Table 2 lists in chronological order the data available on survival of patients with HIV infection or AIDS undergoing maintenance hemodialysis. Early reports influenced the widely held perception of an abysmal outcome for AIDS patients on maintenance dialysis. In 1987, Rao et al. (42) reported that only 2 out of 73 patients with AIDS survived longer than 6 months and that none survived beyond 1 year. In 1988, Ortiz et al. (41) reported a mean survival of only 93 32 days among 17 patients with AIDS. Similar outcomes were reported by others, and the status of dialysis in patients with AIDS was controversial and pessimistic (43). Nevertheless, it was appreciated that not all patients with HIV infection needing dialysis fared poorly. Indeed, Ortiz et al. (41) noted that patients with asymptomatic HIV infection fared relatively well without the benefit of optimal antiviral therapy, consistent and effective prophylaxis for opportunistic infections or reliable permanent vascular access, surviving for a mean duration of 16 2 months. Schoenfeld et al. (31) performed a multivariate analysis of 55 patients dialyzed over 10 years at the San Francisco General Hospital. In their analysis they included variables such as baseline CD4 count, serum albumin, zidovudine use, dialysis modality, and cognitive motor dysfunction. Only cognitive motor dysfunction and CD4 counts correlated significantly with survival. The median survival time for the group was 16 months. When stratified by baseline CD4 count above (55%) and below (45%) 200 cells/L, there was a significant difference in median survival at 26 24 months in the higher group compared with 8.4 7.1 months in the lower. The predictive power of the baseline clinical stage and CD4 cell count of patients on dialysis was confirmed by Perinbasekar et al. (30). In their study, 24 consecutive HIV-infected patients on hemodialysis were evaluated prospectively and retrospectively over 7 years (1987-1993), and clinical and laboratory baseline variables were recorded. All the patients dialyzed with a surgically constructed vascular access. The mean CD4 count in the
Table 1 Long-Term Hemodialysis Centers Reporting Patients with HIV Infection, 1985-1995, United States
Year
Centers with HIV infection
No. (%)
Patients with HIV infection
No. (%)
Patients with clinical AIDS
No. (%)
1985 134 (11) 244 (0.3) — 1986 238 (18) 546 (0.6) 332 (0.4) 1987 351 (24) 924 (1.0) 462 (0.5) 1988 401 (25) 1253 (1.2) 670 (0.6) 1989 456 (26) 1248 (1.0) 663 (0.5) 1990 493 (26) 1533 (1.1) 739 (0.5) 1991 601 (29) 1914 (1.2) 967 (0.6) 1992 737 (34) 2501 (1.5) 1126 (0.7) 1993 792 (34) 2780 (1.5) 1350 (0.7) 1994 914 (37) 3144 (1.5) 1593 (0.8) 1995 1022 (39) 3090 (1.4) 1606 (0.7) Source: Ref. 18.
