Abstract
BACKGROUND: Mortality remains high among people living with HIV (PLHIV) undergoing maintenance hemodialysis (MHD). However, data on the survival of MHD patients in first-tier Chinese cities are limited. This study aimed to analyze the clinical characteristics and survival of PLHIV receiving MHD in Shanghai. METHODS: We conducted a retrospective cohort study at the Blood Purification Center of Shanghai Public Health Clinical Center. Clinical data were collected for PLHIV and HIV-negative controls who initiated MHD between November 2011 and September 2023. Survival was compared using Kaplan-Meier curves, and risk factors were identified through Cox regression analyses. RESULTS: The study included 45 PLHIV and 54 HIV-negative individuals who underwent MHD for over three months. PLHIV were significantly younger at MHD initiation and had a higher proportion of males compared to controls (54.4 ± 14.4 vs. 61.6 ± 16.5 years, p = 0.025; 88.9% vs. 64.8%, p = 0.005). At baseline, the mean CD4 count for PLHIV was 261.1 ± 155.2 cells/µL, and 66.7% (30/45) had undetectable viral loads. The maximum follow-up durations were 145 months for PLHIV and 107 months for controls, with median survival times of 45 months and 61 months, respectively. Survival rates at 12, 24, 36, and 60 months were lower in the HIV group than in the control group (74.8% vs. 88.7%, 71.4% vs. 80.2%, 67.2% vs. 67.7%, and 33.2% vs. 67.7%), with a statistically significant difference observed only at 60 months (p = 0.0343). The overall difference in cumulative survival probability between the two groups was not significant (Log-rank test, p = 0.15). After adjusting for covariates, age ≥ 60 years at MHD initiation was significantly associated with reduced survival in both PLHIV (hazard ratio [HR] 3.14, 95% confidence interval [CI]: 1.15-8.54, p = 0.025) and the entire patient cohort (HR 3.15, 95% CI: 1.31-7.58, p = 0.01). CONCLUSION: PLHIV initiated MHD at a younger age but exhibited lower long-term survival rates, particularly at 60 months, compared to HIV-negative individuals. Age ≥ 60 years at dialysis initiation was an independent risk factor for mortality in PLHIV. TRIAL REGISTRATION: Not applicable.