Page 219 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 9 Original Research

The influence of haemodialysis on CD4+ T-cell counts

in people living with human immunodeficiency

virus with end-stage kidney disease

Authors: Background: In South Africa it is estimated that 7.9 million people are living with human
Melanie Pretorius 1,2,3 immunodeficiency virus (HIV). HIV is associated with an increased risk of kidney disease.
Estee Benade 4
June Fabian 5 For people living with HIV (PLWH) who develop end-stage kidney disease (ESKD), access
Denise Lawrie 1,2,3 to renal replacement therapy can be difficult. Kidney transplantation is a cost-effective
Elizabeth S. Mayne 2,3,6 option, with improved overall survival and better quality of life. In Johannesburg, the

Affiliations: eligibility criteria for kidney transplantation include a sustained CD4+ T-cell count of > 200
1 Department of Molecular cells/µL and suppressed HIV replication.
Medicine and Haematology,
Faculty of Health Sciences, Objective: To investigate the influence of haemodialysis on the lymphocyte subsets in PLWH
University of the with ESKD. In addition, all available %CD4+ T-cell counts, absolute CD4+ T-cell counts and
Witwatersrand, Johannesburg, viral load measurements were collected to assess the longitudinal trends of these measurements
South Africa
in PLWH with ESKD.
2 National Health Laboratory Methods: This was a cross-sectional study comparing two groups. The HIV-infected study
Services, Johannesburg,
South Africa participants (n = 17) and HIV-uninfected controls (n = 17) were recruited from renal dialysis
centres in Johannesburg from 2017 to 2018. Demographic data and social data were collected
3 Charlotte Maxeke from all the study participants (n = 17). Blood samples were collected from all the study
Johannesburg Academic participants (before and after a haemodialysis session), and the lymphocyte subsets were then
Hospital, Johannesburg,
South Africa measured. The available longitudinal data for the serial CD4+ T-cell counts and HIV viral loads
were collected (n = 14).
4 Department of Laboratory
Medicine, Saskatchewan Results: Our cohort showed a statistically significant increase in the post-dialysis percentage
Health Authority, Regina, of CD4+ T cells (5%, p < 0.001) and the absolute CD4+ T-cell counts (21 cells/µL, p < 0.03). The
Saskatchewan, Canada longitudinal trend analysis for the percentage of CD4+ T cells revealed a significant increase in
five participants (36%), and a single patient (7%) had a significant decrease in the longitudinal
5 School of Clinical Medicine,
Faculty of Health Sciences, trend analysis for the absolute CD4+ T-cell counts. The longitudinal trend analysis for HIV
Wits Donald Gordon Medical viral load revealed the majority of our participants were not virologically suppressed.
Centre, University of the
Witwatersrand, Conclusion: This study showed that haemodialysis does not have an immediate negative
Johannesburg, South Africa impact on CD4+ T-cell count, suggesting that immunologic recovery is not impeded by
treatment of the underlying ESKD.
6 Department of Immunology,
Faculty of Health Sciences, Keywords: CD4 T-cell count; hemodilaysis; transplantation; infectious diseases; HIV.
University of the
Witwatersrand,
Johannesburg, South Africa
Context
Corresponding author:
Elizabeth Mayne, In South Africa, human immunodeficiency virus (HIV) infection remains a leading healthcare
[email protected] concern. In 2016, it was estimated that approximately 7 million people are infected (according to
STATS SA). Of these 7 million HIV-infected patients, only 70.7% (~5.3 million) of patients are
Dates: currently receiving combined antiretroviral therapy (ART). 1
Received: 07 July 2020
Accepted: 02 Oct. 2020
Published: 21 Dec. 2020 HIV infection leads to widespread immunological and subsequent organ dysfunction. End-
stage kidney disease (ESKD) in HIV infection has been attributed to a number of causes
(Table 1) including HIV-mediated renal damage, exposure to nephrotoxic agents including
tenofovir disoproxil fumarate and the presence of opportunistic infections. In patients on
ART, with a reduction in opportunistic infections, there is a concomitant increased prevalence
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 211 Open Access