233564 Prevalence of Co-morbidities among HIV-infected Chronic Kidney Disease(CKD-Stage-5)/End-Stage Renal Disease(ESRD) Patients according to their Renal Replacement Therapy (RRT) Modality in the French Renal Epidemiology Information Network (REIN) Registry

Tuesday, November 9, 2010

Ghazal Soleimani, MEd , Department of Epidemiology and Biostatistics, Robert Stempel School of Public Health &Social Work, Florida International University, Miami, FL
Cécile Couchoud, MD , Agence de la biomédecine, Coordination nationale de REIN, SAINT DENIS LA PLAINE CEDEX, Paris, France
Mary Jo Trepka, MD, MSPH , Stempel College of Public Health and Social Work, Florida International University, Miami, FL
Timothy Page, PhD , Health Policy and Management, Florida International University, Miami, GA
Jerome Tourret, MD , Groupe Hospitalier Pitié Salpêtrière, Service de Néphrologie du Pr Deray, 75651, Paris Cedex 13, France
Background:Nearly 1% of all patients with stage-5 chronic kidney disease(CKD-stage-5)in the US and Europe are estimated to be infected with human immunodeficiency virus(HIV).Their dual pathology represents a growing therapeutic challenge.This study aimed to determine the point prevalence,and clinical characteristics of HIV-infected patients in the French Renal Epidemiology Information Network(REIN)registry.

Methods:Cross-sectional analysis of all HIV-infected registry patients undergoing renal replacement therapy(RRT (i.e.hemodialysis[HD],peritoneal-dialysis[PD],or renal transplantation),as of December,31,2007.Variables analyzed included co-morbidities,age,gender,body mass index(BMI),country of origin,and time on RRT. Chi-square testing;and t-tests were used as appropriate with SAS(version 9.2).Three prevalence rates were calculated for HIV-infected,RRT patients,using as denominators:1)French population;2)French HIV-infected adult population;3)French,RRT population.

Results:Of the 381,HIV-infected RRT patients from the REIN,there were 238 males,and 143 females;with 317 on HD,7 on PD,and 57 with functioning renal grafts.The median age and time on RRT was 50.0 and 6.0 years,respectively.The prevalence of HIV-infection and RRT was 6.8 per 1000 French population,2.7 per 1000 HIV-infected adults in France,and 12.0 per 1000 French,CKD-Stage-5 patients. No differences existed in gender,age,BMI,hepatitis-B-co-infection,RRT time,or diabetes,between the three RRT modalities.However,no transplant patients had hepatitis-C(HCV),compared with 15.8% in the HD,and 14.3% in the PD groups(p<0.01).No HIV-infected transplant patients had chronic heart disease(CHD)declared in the REIN,compared to HD(21.5%) patients(p<0.0001).Most dialysis patients were of African descent(59.8%),whereas transplant patients were mainly of European descent(75.0%).

Conclusions:Findings suggest that HIV-infected transplant patients have less HCV and CHD than their PD&HD counterparts.Our results are consistent with the current literature showing an HIV prevalence of nearly 1%,among RRT patients.The limitations of this study include the relatively small number of patients in addition to some missing co-morbidity data.

Learning Areas:
Biostatistics, economics
Chronic disease management and prevention
Clinical medicine applied in public health
Diversity and culture
Public health or related public policy

Learning Objectives:
•Describe clinical characteristics and co-morbidities affecting HIV-positive RRT patients in France. •Identify the point prevalence of HIV-positive RRT patients among the entire French population, the French HIV+ population, and the French end stage renal disease/CKD Stage-5 population. •Compare differences between French HIV+ patients by modality of RRT.

Keywords: Chronic Diseases, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because I am a nephrologist working in Paris with renal replacement therapy (RRT) patients including those on dialysis and with renal transplantation. Further, I am a medical specialist in the are of HIV among RRT and dialysis patients.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.