Dialysis and renal transplantation

The number of HIV-infected patients with ESRD is increasing⁵⁵. These patients may require treatment with dialysis or renal transplantation, usually in centres with expertise in this area. The one-year survival rate of patients with HIV infection on dialysis has improved recently, although the rate remains inferior to that of the population without HIV infection⁵⁶. These improvements may reflect the changing aetiology of renal disease in people with HIV infection. Renal transplantation is safe and effective in patients with HIV infection⁵⁷.  Assessment of a patient’s suitability for renal transplantation is recommended for all Australian patients with HIV infection and ESRD. Patient selection for transplantation is usually performed in centres with experience in both the management of HIV infection and in renal transplantation⁵⁸. Results of renal transplantation in HIV-infected patients are favourable, particularly if these patients have an undetectable HIV viral load and no history of opportunistic infections or cancer, although, reported outcomes are inferior to the patient group without HIV infection^37,58. Acute renal allograft rejection is reported more commonly in patients with HIV infection undergoing renal transplantation. Medication interactions and polypharmacy are also important considerations in this setting³⁷.