Croatian Recommendations for Dialysis of HIV-Positive Patients

Open access


Human immunodeficiency virus (HIV) infection may be associated with renal impairment since about 0.4% of all HIV-positive patients develop end-stage renal disease. The share of patients with HIV infection in hemodialysis centers throughout the world ranges from 0.3% to as high as 38%. In Croatia, renal replacement therapy was needed by 1% of all the HIV-positive patients from 1985 until the end of 2014. Healthcare professionals (HP) should be aware of the risks of occupational exposure to blood-borne infections in their daily work. Performing dialysis in HIV-positive patients increases the risk of exposure to HIV during the extracorporeal circulation of the infected blood. However, post-exposure prophylaxis (PEP) with effective antiretroviral drugs significantly reduces the risk of infection after occupational exposure. On behalf of the Croatian Society of Nephrology, Dialysis and Transplantation, the authors of this paper have proposed recommendations for the management of HIVpositive patients on dialysis, which aim to prevent the transmission of HIV among patients and HPs. The important recommendations include the following: 1. when the need arises, it is necessary to provide HIV-positive patients with dialysis in the vicinity of their place of residence. 2. HIV-positive patients should be dialyzed with a separate hemodialysis machine in an isolated area. Alternatively, they can be dialyzed in an area for the hemodialysis of HCV-positive and/or HBVpositive patients. 3. Specialized and trained personnel should be provided during the hemodialysis procedure, together with strict compliance with the standard precautions for the prevention of blood-borne infections. 4. There should be a good and prompt cooperation with the National Referral Center for HIV infection.

1. Center for Disease Control and Prevention. Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs. MMWR 1982; 31: 577-580.

2. May MT, Gompels M, Delpech V, et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS 2014; 28(8): 1193-1202.

3. TEMPRANO ANRS 12136 Study Group. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med 2015; 373(9): 808-822.

4. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015; 373(9): 795-807.

5. van Sighem AI, Gras LA, Reiss P, et al. ATHENA national observational cohort study. Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals. AIDS 2010; 24(10): 1527-1535.

6. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382: 1525-1533.

7. High KP, Brennan-Ing M, Clifford DB, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr 2012; 60(suppl 1): S1-18.

8. Ryom L, Mocroft A, Kirk O, et al. Predictors of advanced chronic kidney disease and end-stage renal disease in HIVpositive persons. AIDS 2014; 28(2): 187-199.

9. Fine DM, Perazella MA, Lucas GM, Atta MG. Renal disease in patients with IV infection: epidemiology, pathogenesis and management. Drugs 2008; 68(7): 963-980.

10. Trullas JC, Mocroft A, Cofan F, et al. Dialysis and renal transplantation in HIV-infected patients: a European survey. J Acquir Immune Defic Syndr 2010; 55(5): 582-589.

11. Gathogo E, Jose S, Jones R, et al. End-stage kidney disease and kidney transplantation in HIV-positive patients. J Acquir Immune Defic Syndr 2014; 67(2): 177-180.

12. Natov SN, Murthy BVR, Pereira BJG. Hepatitis and human immunodeficiency virus infection in end-stage renal disease patients. In: Henrich WL, ed. Principle and practice of dialysis, 3rd ed., Lippincott Williams & Wilkins. Philadelphia- Baltimore-New York-London-Buenos Aires-Hong Kong-Sydney- Tokyo.2004; 323-351.

13. Ahuja TS, O`Brien WA. Special issues in the management of patients with ESRD and HIV infection. Am J Kidney Dis 2003; 41: 279-291.

14. Sheridan AM. Deputy Editor, Nephrology UpToDate. Human immunodeficiency virus and dialysis.

15. Fabrizi F, Lunghi G, Ponticelli C. Epidemiology of human immunodeficiency virus (HIV) infection in dialysis: recent insights. Int J Artif Organs 2001; 24: 425-433.

16. Gerberding JL. Management of occupational exposures to bloodborne viruses. N Engl J Med 1995; 332(7): 444-451.

17. Civljak R, Begovac J. Occupational Exposure of Healthcare Personnel to Bloodborne Infections. Infektol Glasn 2003; 23(4): 183-188.

18. CDC. Updated U.S. Public Health Service. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Postexposure Prophylaxis. MMWR Morb Mortal Wkly Rep 2001; 50: 1-52.

19. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Center for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997; 337(21): 1485-1490.

20. Gerberding JL. Clinical practice. Occupational exposure to HIV in health care settings. N Engl J Med 1997; 348(9): 826-833.

21. Anonimo. Needlestick transmission of HTLV-III from patient infected in Africa (Editorial). Lancet 1984; 2(8416): 1376-1377.

22. Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987; 36(suppl 2): S1-S18.

23. CDC. National Institute for Occupational Safety and Health. NIOSH Alert: Preventing needlestick injuries in health care settings. DHHS (NIOSH) Publication No. 2000-108/1999.

24. Joyce PM, Kuhar D, Brooks JT. Notes from the field: Occupationally acquired HIV infection among health care workers-United States, 1985-2013. MMWR 2015; 63(53): 1245-1246.

25. Tokars JI, Alter MJ, Miller E, et al. National surveillance of dialysis associated disease in the United States, 1994. ASAIO J 1997; 43(1): 108-109.

26. Jagger J, De Carli G, Perry J, et al. Occupational exposure to bloodborne pathogens: epidemiology and prevention. In: Wenzel RP, ed. Prevention and control of nosocomial infections. 4th ed., New York: Lippincott, Williams & Wilkins 2003.

27. European Best Practice Guidelines Expert Group on Hemodialysis, European Renal Association EBPG for HD Part 1. VI.6 Prevention and management of HBV, HCV and HIV in HD patients. Nephrol Dial Transplant 2002; 17(suppl 7): S78-S81.

28. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of hepatitis C in chronic kidney disease. Kidney Int 2008; 73(Suppl 109): S1-S99.

29. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Disease Society of America. Clin Infect Dis 2005; 40: 1559-1585.

30. Moosa MR, Naicker S, Naiker I, et al. Guidelines for the Optimal Care of Patients on Chronic Dialysis in South Africa. Cape Town: Subcommittee of the South African Renal Society (SARS), 2006.

31. Racki S, Basic-Jukic N, Kes P, et al. Treatment of anemia in chronic kidney disease-position statement of the Croatian Society for Nephrology, Dialysis and Transplantation and review of the KDIGO and ERPB guidelines. Acta Med Croatica 2014; 68: 215-221.

32. Lucas GM, Ross MJ, Stock PG, et al. Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected with HIV: 2014 Update by the HIV Medicine. Clin Infect Dis 2014; 59(9): e96-e138.

33. Velandia M, Fridkin SK, Cardenas V, et al. Transmission of HIV in dialysis centre. Lancet 1995; 345: 1417-1422.

34. Perez GO, Ortiz C, De Medina M, et al. Lack of transmission of human immunodeficiency virus in chronic hemodialysis patients. Am J Nephrol 1988; 8: 123-126.

35. Leads from the MMWR. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. JAMA 1988; 260: 462-465.

36. CDC. HIV transmission in a dialysis center-Colombia, 1991-1993. MMWR 1995; 44: 404-402.

37. Arenas Jimenez D, Sanchez-Paya J, Gonzales C, et al. Audit on the degree of application of universal precautions in a haemodialysis unit. Nephrol Dial Transplant 1999; 14: 1001-1003.

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 308 308 17
PDF Downloads 93 93 10