Page 225 - HIVMED_v21_i1.indb

Page 7 of 9 Original Research

16
donor transplantation. Ongoing investigations are being participants. As the control group comprised HIV-
conducted to establish the optimal absolute CD4+ T-cell uninfected individuals, routine CD4+ T cell testing is not
count for the best possible outcome. It appears that an performed in these patients.
absolute CD4+ T-cell count of 200 cells/µL may be inadequate
to protect against adverse outcomes including post-transplant This study failed to show a negative effect of haemodialysis
17
opportunistic infections. A study conducted in our setting on the CD4+ T-cell count. However, unexpectedly, the
evaluating the longitudinal trends of PLWH with ESKD on absolute CD4+ T-cell count increases immediately post-
chronic haemodialysis found an annual increase in the dialysis, suggesting that immunologic recovery is not
longitudinal absolute CD4+ T-cell counts in PLWH with impeded by the treatment of the underlying ESKD. Further
ESKD on chronic haemodialysis. 23 studies are required to ascertain the possible reasons for a
rise, how long this rise is sustained and whether these
The frequency of HIV viral load testing performed varied CD4+ T cells are functional. Of concern, the patients in this
amongst the different centres treating these patients. The study failed to show virological suppression; because this
current national HIV treatment guidelines state that the is a key driver of disease progression and complications
immunological (CD4+ T-cell count) and virological (HIV including non-communicable diseases, this requires urgent
viral load) parameters should be measured at initially 6- investigation.
then 12-monthly intervals in PLWH. The majority of our
24
patients were not virologically suppressed despite this Acknowledgements
being an eligibility criterion for deceased donor kidney
transplantation. This, however, is not an uncommon finding The authorswould like to acknowledge all the nursing staff
in PLWH with ESKD on chronic haemodialysis. Studies in the various renal dialysis units for their time and assistance.
assessing the longitudinal HIV viral loads in PLWH having We would also like to acknowledge Ms L. Moreira and Ms M.
ESKD on chronic renal dialysis found approximately half of Moselekwa for all their guidance and assistance.
their cohort of patients did not have a suppressed HIV viral
load. 23,25 Possible reasons include haemodialysis, itself, Competing interests
which may lead to an increase in HIV replication because of The authors have declared that no competing interest
the release of specific cytokines as well as the use of certain exist.
dialysis membranes during the haemodialysis procedure. 26,27
Other possible causes include unreliable adherence to ART,
inexperience with prescribing ART (suboptimal dosing as a Authors’ contributions
result of the renal failure), infrequent consultations with All authors contributed equally to this work.
infectious diseases specialists, patient compliance and ART
timing (before or after haemodialysis) which in turn could Funding information
influence drug concentrations. 23
This research received no specific grant from any funding
This study has numerous limitations. Firstly, the number agency in the public, commercial or not-for-profit sectors.
of PLWH having ESKD currently receiving chronic
haemodialysis in four different academic centres in Data availability statement
Johannesburg is small. It is likely that the small number
reflects the strict qualification criteria for dialysis and the Data sharing is not applicable to this article as no new data
limited dialysis slots available. Secondly, the selection of were created or analysed in this study.
the study participants was not randomised and selection
bias cannot be excluded in this cohort of patients. In Disclaimer
addition, the exact date when haemodialysis was started The views and opinions expressed in this article are those of
for each patient is not certain, and it is also not certain the authors and do not necessarily reflect the official policy or
whether all the participants were on ART and the position of any affiliated agency of the authors.
compliance of the patients to their treatment; the data on
longitudinal CD4+ T-cell counts and viral loads were not References
always available and the timing of testing were inconsistent
with respect to dialysis sessions although the longitudinal 1. Marinda E, Simbayi L, Zuma K, et al. Towards achieving the 90-90-90 HIV targets:
Results from the South African 2017 national HIV survey. BMC Public Health.
trend appears to support the peri-dialysis cross-sectional 2020;20(1):1375. https://doi.org/10.1186/s12889-020-09457-z
data. For the same reason, it is not possible to assess the 2. Boswell MT, Rossouw TM. Approach to acute kidney injury in HIV-infected patients
in South Africa. South Afr J HIV Med. 2017;18(1):714. https://doi.org/10.4102/
correlations between the T-cell profiles with the viral load sajhivmed.v18i1.714
before and after the start of dialysis. It was not possible in 3. Diana NE, Naicker S. Update on current management of chronic kidney disease in
patients with HIV infection. Int J Nephrol Renovasc Dis. 2016;9:223–234. https://
this small study to perform ART monitoring to ensure that doi.org/10.2147/IJNRD.S93887
the absence of virological suppression did not reflect the 4. Siemens TA, Riella MC, Moraes TP, Riella CV. APOL1 risk variants and kidney
disease: What we know so far. J Bras Nefrol. 2018;40(4):388–402. https://doi.
lack of adherence. Unfortunately, a control group could org/10.1590/2175-8239-jbn-2017-0033
not be added to the longitudinal analyses of the study 5. Himmelfarb J, Ikizler TA. Hemodialysis. New Eng J Med. 2010;363(19):1833–1845.
https://doi.org/10.1056/NEJMra0902710
http://www.sajhivmed.org.za 217 Open Access