Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Compared to HIV-negative kidney transplant (KT) candidates, the median time to waiting list activation is longer among HIV-positive candidates. Little is known about potential barriers to active KT listing among HIV-positive individuals with advanced chronic kidney disease (CKD). We sought to characterize comorbidities, viral control and management, viral resistance profiles, and KT referral rates among a cohort of HIV-positive individuals with advanced CKD.
*Methods: In this retrospective cohort study, we identified patients seen between January 1, 2008 and December 31, 2015 at a primary care HIV clinic who were eligible for KT wait-listing by estimated glomerular filtration rate criteria (eGFR) criteria (i.e., eGFR of < 20 ml/min/1.73 meters2) or due to dialysis-dependence. Outcomes were KT evaluation referral, time to referral, and attendance at the transplant evaluation appointment.
*Results: Among sixty-one patients who were eligible for KT listing, the median age was 47 years; 77% were men; 95%, black; and 2%, Hispanic. Median BMI was 25.8 (IQR 22.6-28.9) and median year of HIV diagnosis was 1995 (IQR 1991-2000). Among the 58% percent who were prescribed anti-retroviral therapy (ART), 62% had viral loads > 20 copies and 47% had viral loads > 200 copies. Among patients with HIV resistance profiles (49%, n=30), 30% had resistance to at least one class of ART. Psychiatric disease was documented among 52%, of which 10% was schizophrenia, and 49% had a history of drug abuse. Transplant referral occurred in 62% (n = 37) of which 35% were within 12-months of meeting eligibility. Among those who received referral, only11% (n = 4) never attended a KT evaluation appointment. Baseline characteristics were similar between patients with and without referrals, save for significantly higher prevalence of schizophrenia in those without referral (3% vs. 21%, p = 0.03).
*Conclusions: Despite receiving care at a primary care HIV clinic, the majority of HIV-positive patients with advanced CKD in this study did not have adequate viral suppression. This finding and the high prevalence of psychiatric disease observed may represent potentially addressable barriers to timely KT wait-listing.
To cite this abstract in AMA style:Boyle SM, Fehr K, Deering C, Raza A, Harhay M, Malat G, Ranganna K, Lee D. Barriers to Kidney Transplant Wait Listing among HIV Positive Patients with Advanced Kidney Disease [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/barriers-to-kidney-transplant-wait-listing-among-hiv-positive-patients-with-advanced-kidney-disease/. Accessed September 30, 2020.
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