Recently, researchers reportedon a national study comparingoutcomes among theentire U.S. cohort of HIV-infectedkidney transplant recipients withappropriately matched HIV-negativecontrols. The study, published onlinein the Journal of the American Societyof Nephrology, found that HIV-infectedpatients who were not co-infectedwith hepatitis C virus had5- and 10-year graft and patient survivalrates similar to those of HIV-negative recipients. The researchersnoted that chronic diseases such as end-stage renal disease (ESRD)have now surpassed opportunistic infections as the leading cause ofdeath among HIV-infected patients. The study got me thinking aboutthe evolution of HIV disease in the United States and how AIDS hasslipped from public view compared with, say, 2 decades ago.
The Centers for Disease Control and Prevention (CDC) estimatesthat more than 1.2 million people aged 13 years and older in the UnitedStates are living with HIV infection, and the number is increasing. In2013, an estimated 47,352 people were diagnosed with HIV infectionand an estimated 26,688 were diagnosed with AIDS in the UnitedStates. HIV/AIDS remains a serious epidemic, yet it gets relativelylittle coverage in the mainstream media these days, unlike in the past,when AIDS reports appeared almost daily, and, not uncommonly, onnewspaper front pages.
One reason, I suspect, is that the advent of highly active antiretroviraltherapy (HAART) in the mid-1990s transformed AIDS from afatal to a chronic illness, at least in the United States. The incidenceof opportunistic infections and virus-related malignancies—the maincauses of death among AIDS patients—plummeted. In 1995, aroundthe time of HAART’s debut, 50,876 deaths were reported amongadults or adolescents diagnosed with AIDS (although these deathsmay or may not be related to AIDS), according to the CDC. In 2013,the figure was 13,712.
The increased life expectancy of HIV-infected patients and thecontinued growth of the HIV-infected population have implicationsfor nephrologists and urologists, who may now see more and moreof these patients presenting with the same renal and other urinarytract problems seen in the general non-HIV-infected population.Nephrologists will likely be managing more HIV-infected dialysis andtransplant patients, given that chronic kidney disease is a commoncomplication of HIV disease.
Although the care of HIV-infected patients may present concernsand challenges, such as the potential danger of HIV transmission, itshould give clinicians some satisfaction to know they are tending tothe needs of individuals who, prior to HAART, might not have livedlong enough to require their professional services.