Barriers to kidney transplant evaluation in HIV-positive patients with advanced kidney disease: A single-center study.
BACKGROUND
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.


METHODS
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 meters2 or dialysis dependence. The primary outcome was a documented appointment for KT evaluation.


RESULTS
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/mm3 (IQR 175-461). Among the 63% percent with antiretroviral 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 = .02), resistance (78% vs 33%, P = .04), ART prescription (76% vs 48%, P = .04), and more kidney disease of unknown etiology (53% vs 8%, P = .02).


CONCLUSION
Kidney transplant 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.
['Boyle|Suzanne M|SM|https://orcid.org/0000-0003-4062-8954', 'Fehr|Kallie|K|', 'Deering|Catylin|C|', 'Raza|Abbas|A|', 'Harhay|Meera N|MN|', 'Malat|Gregory|G|', 'Ranganna|Karthik|K|', 'Lee|Dong Heun|DH|']
D000328:Adult D044966:Anti-Retroviral Agents D018791:CD4 Lymphocyte Count D057286:Electronic Health Records D004608:Eligibility Determination D005260:Female D005919:Glomerular Filtration Rate D015658:HIV Infections D006801:Humans D007674:Kidney Diseases D016030:Kidney Transplantation D008297:Male D008875:Middle Aged D012189:Retrospective Studies D019562:Viral Load
kidney transplant kidney transplant evaluation HIV disparity