HIV-positive kidney transplant (KT) recipients have similar outcomes to HIV-negative recipients. However, HIV-positive patients with advanced kidney disease might face additional barriers to initiating the KT-evaluation process. We sought to characterize comorbidities, viral control and management, viral resistance, and KT evaluation appointment rates in a cohort of KT evaluation-eligible HIV-positive patients.
We included patients seen between January 1, 2008 and December 31, 2015 at a primary care HIV clinic who met KT-evaluation eligibility by an estimated glomerular filtration rate ≤ 20 ml/min/1.73 meters or dialysis-dependence. The primary outcome was a documented appointment for KT evaluation.
Of 3735 patients evaluated at the HIV primary clinic during the study period, 42 (1.6%) were KT evaluation-eligible patients. The median age was 47 years, 77% were male, and 95%, black. Median CD4 count was 328 cells/mm (IQR 175-461). Among the 63% percent with anti-retroviral therapy (ART) prescription, 40% had viral loads > 200 copies. Among patients with HIV resistance profiles (50%, n=21), 52% had resistance to at least one class of ART. A majority (60%, n = 25) were scheduled for KT-evaluation appointment, but of those, only 8% (n = 2) had evidence of appointments before dialysis-dependence. Those without appointments had more schizophrenia (29% vs. 4%, p = 0.02), resistance (78% vs. 33%, p = 0.04), ART prescription (76% vs. 48%, p = 0.04), and more kidney disease of unknown etiology (53% vs. 8%, p = 0.02).
KT evaluation-eligible HIV-positive patients had a high rate of evaluation appointments, but a low rate of preemptive evaluation appointments. Schizophrenia and viral resistance disproportionally affected patients without evaluation appointments. These data precede the recommendation for universal ART for all HIV+ patients, regardless of CD4 count and viral load, and must be interpreted in the context of this limitation.
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.