The effects of HIV infection on peritoneal dialysis associated peritonitis

AUTHORS:  

KCZ. Ndlovu 1,2, A Assounga 1,2

1. Inkosi Albert Luthuli Central Hospital, Durban, South Africa 

2. University of KwaZulu-Natal, Durban, South Africa

INTRODUCTION 

This study aims to evaluate infective complications of continuous ambulatory peritoneal dialysis (CAPD) in the management of renal failure associated with HIV infection.

METHODS

This is an ongoing prospective study carried out on dialysis requiring renal failure patients newlyinsertedatenckhoffcatheterinourunitstartedon1September2012. FortyHIVpositive patients and 59 HIV negative controls were enrolled into groups 1 and 2, respectively, by 31 March 2014. Monthly follow up data over 6 months was used to assess outcomes of catheter associated infective complications.

RESULTS

Both groups 1 and 2 had statistically comparable proportion of patients with removed catheters at 6 months (20% vs 15%, respectively, p=0.539), with severe or non-resolving peritonitis being the largest cause for catheter failure accounting for 63% and 89% of all catheter failures in each group, respectively. However, the HIV positive group had an unadjusted statistically significant increased peritonitis rate (1.65 vs 0.60 per-person-years, RR 2.78, 95% CI 1.29 – 6.18, p=0.0052), and Cox regression hazard ratios against peritonitis free days (HR 2.53, CI 1.23 – 5.18, p=0.011). Factors associated with increased peritonitis risk were CD4 count of less than 200/?l, unsuppressed viral load, and ARV duration of less than 6 months linked to hazard ratios of 5.27 (95% CI 2.14 to 12.98, p<0.001), 4.68 (CI 1.98 to 11.05, p<0.001), and 3.42 (CI 1.49 to 7.86, p=0.004), respectively. Both groups had statistically similar mean days to first peritonitis episode (59.9 vs 54.8, p=0.755), mean presenting PD WCC (3019.6 vs 2224 /?l, p=0.529), and cultured microorganism patterns (33% vs 36% gram positive, 44% vs 36% gram negative, 22% vs 21% culture negative, 0% vs 7% fungal, respectively, p=0.694).

CONCLUSION: 

This study suggests that uncontrolled HIV infection in patients managed by CAPD may be associated with a higher peritonitis risk, however, with similar presenting features.