Morbidity and mortality of black HIV-positive patients with end-stage kidney disease receiving chronic haemodialysis in South Africa

Abstract

South Africa (SA) has the highest prevalence of HIV/AIDS of any country in the world, which adds complexity to a health system already overwhelmed by chronic kidney disease, particularly that due to hypertension, diabetes and chronic glomerulonephritis. Renal disease is common in HIV-infected individuals. Prior to availability of ART, HIV was a death sentence for individuals with chronic kidney disease (CKD). However, since ART roll-out there is growing evidence of little difference in survival between HIV-infected patients who are receiving efficacious ART compared with the general population on dialysis. In this issue of the SAMJ, Fabian et al. demonstrate that haemodialysis in black African HIV-positive patients in the private sector in SA imparts excellent overall survival. This study contributes to the growing data reflecting good outcomes for HIV-positive patients on dialysis. However, transplantation is regarded as the best treatment option for CKD in patients without HIV, and we ask whether we should not be striving for dialysis to be the bridge to transplantation in HIV-positive patients. Also, importantly, attention needs to be geared towards prevention of CKD and slowing progression towards end-stage renal disease (ESRD). Those who provide healthcare to HIV-positive patients need to be aware of the special renal issues relevant to HIV, and the potential for evolution to ESRD.