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The influence of haemodialysis on CD4+ T-cell counts in people living with human immunodeficiency virus with end-stage kidney disease

Authors
  • Pretorius, Melanie1, 2, 3
  • Benade, Estee4
  • Fabian, June5
  • Lawrie, Denise1, 2, 3
  • Mayne, Elizabeth S.2, 3, 6
  • 1 Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • 2 National Health Laboratory Services, Johannesburg, South Africa
  • 3 Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
  • 4 Department of Laboratory Medicine, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  • 5 School of Clinical Medicine, Faculty of Health Sciences, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
  • 6 Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Type
Published Article
Journal
Southern African Journal of HIV Medicine
Publisher
AOSIS
Publication Date
Dec 21, 2020
Volume
21
Issue
1
Identifiers
DOI: 10.4102/sajhivmed.v21i1.1125
PMID: 33391830
PMCID: PMC7756925
Source
PubMed Central
Keywords
Disciplines
  • Original Research
License
Green

Abstract

Background In South Africa it is estimated that 7.9 million people are living with human immunodeficiency virus (HIV). HIV is associated with an increased risk of kidney disease. For people living with HIV (PLWH) who develop end-stage kidney disease (ESKD), access to renal replacement therapy can be difficult. Kidney transplantation is a cost-effective option, with improved overall survival and better quality of life. In Johannesburg, the eligibility criteria for kidney transplantation include a sustained CD4+ T-cell count of > 200 cells/μL and suppressed HIV replication. Objective To investigate the influence of haemodialysis on the lymphocyte subsets in PLWH with ESKD. In addition, all available %CD4+ T-cell counts, absolute CD4+ T-cell counts and viral load measurements were collected to assess the longitudinal trends of these measurements in PLWH with ESKD. Methods This was a cross-sectional study comparing two groups. The HIV-infected study 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 from all the study participants ( n = 17). Blood samples were collected from all the study participants (before and after a haemodialysis session), and the lymphocyte subsets were then measured. The available longitudinal data for the serial CD4+ T-cell counts and HIV viral loads were collected ( n = 14). Results Our cohort showed a statistically significant increase in the post-dialysis percentage of CD4+ T cells (5%, p < 0.001) and the absolute CD4+ T-cell counts (21 cells/µL, p < 0.03). The 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 trend analysis for the absolute CD4+ T-cell counts. The longitudinal trend analysis for HIV viral load revealed the majority of our participants were not virologically suppressed. Conclusion This study showed that haemodialysis does not have an immediate negative impact on CD4+ T-cell count, suggesting that immunologic recovery is not impeded by treatment of the underlying ESKD.

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