Document Detail


Hemodialysis access: influence of the human immunodeficiency virus on patency and infection rates.
MedLine Citation:
PMID:  10194487     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The complication rate for patients who are dialysis dependent and infected with the human immunodeficiency virus (HIV) and the role of viral indicators (CD4 counts) as predictors of these complications are poorly characterized. To determine the influence of HIV status and viral activity on graft patency and infection rates, we retrospectively reviewed our results.
METHODS: Between June 1993 and March 1997, the charts of 104 patients (HIV+, n = 42; HIV-, n = 62) who required 112 hemodialysis access grafts were reviewed. Of the 112 procedures, 55 (48%) were autologous arteriovenous fistulae (AVF) procedures (HIV+, n = 23; HIV-, n = 32) and 57 (52%) were prosthetic expanded polytetrafluoroethylene grafting procedures (HIV+, n = 27; HIV-, n = 30). Transcutaneous catheter procedures were excluded from the study. The autologous AVF procedures consisted of direct and transposed AVFs. Patency rates were determined by means of life-table analysis. Infection rates and CD4 counts were compared with the chi2 test and the Fisher exact test. Significance was accepted at a P value of.05 or less.
RESULTS: The cumulative 12-month and 24-month patency rates for prosthetic grafts in patients who were HIV+ were 49% and 21%, respectively, versus 77% and 45% for patients who were HIV-. The differences in the prosthetic graft patency rates between these two groups were significant (P </=.05). The cumulative 12-month and 24-month patency rates for autologous AVF procedures did not differ significantly. The AVF procedure patency rates were 72% and 51%, respectively, in patients who were HIV+ versus 54% and 50% for patients who were HIV-. The prosthetic graft infection rate for patients who were HIV+ and HIV- were 30% and 7%, respectively ( P =.04). However, the infection rates in autologous AVF procedures did not differ between the groups (9% vs 0%; P>.05). The mean CD4+ cell counts were 174: CD4+ counts that were less than 200 did not correlate with or predict the development of infection (P >.05).
CONCLUSION: Our data showed that prosthetic graft infection rates were increased and patency rates were decreased in patients who were HIV+ as compared with patients who were HIV- and HIV+ with autologous AVFs. There were no differences in patency rates or infection rates in patients who had undergone autologous access procedures. Long-term graft patency rates were not affected by HIV status, and CD4+ lymphocyte counts were not predictive of infection development. Because the prosthetic graft infection rates exceeded those rates of autologous access procedures, we recommend the vigorous use of autologous AVFs in all patients who are HIV+, regardless of CD4+ count.
Authors:
M A Curi; P J Pappas; M B Silva; S Patel; F T Padberg; Z Jamil; W N Durán; R W Hobson
Related Documents :
8097417 - Zalcitabine.
19005267 - The effect of antiretroviral treatment of different durations in primary hiv infection.
18593347 - Hepatitis c virus coinfection does not affect cd4 restoration in hiv-infected patients ...
19478647 - Treatment of spondylodiscitis in human immunodeficiency virus-infected patients: a comp...
2693527 - I.v. drug use and aids: public policy and dirty needles.
16912447 - Bacteriological techniques compliment the clinical and cytological diagnosis of tubercu...
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  29     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-05-05     Completed Date:  1999-05-05     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  608-16     Citation Subset:  IM; X    
Affiliation:
Division of Vascular Surgery and Program in Vascular Biology, Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Blood Vessel Prosthesis Implantation
CD4 Lymphocyte Count
Catheters, Indwelling
Female
HIV Infections / complications*,  physiopathology*
Humans
Life Tables
Male
Middle Aged
Renal Dialysis*
Retrospective Studies
Vascular Patency*
Grant Support
ID/Acronym/Agency:
K07 HL03437-02/HL/NHLBI NIH HHS; KO8 HL03354-03/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Arterial aneurysms in patients infected with human immunodeficiency virus: a distinct clinicopatholo...
Next Document:  Renal artery stenosis treated with stent deployment: indications, technique, and outcome for 108 pat...