Dialysis in AIDS patients: a new problem.

Juan M. López-Gomez, Service of Nephrology, Hospital Provincial, Dr. Esquerdo, 46, E-28007 Madrid (Spain) Dear Sir, Acquired immunodeficiency syndrome (AIDS) is currently an important problem for medical practitioners. Although a lot has been written about the prophylaxis of AIDS transmission among homosexuals, hemophiliacs, and health workers who care for these patients, little has been written about the need for dialysis in cases of renal failure. The etiologic agent of this illness is a retrovirus from the family of human T cell leukemia viruses, called HTLV-ΠI or lymphadenopathy-associated virus (LAV). The disease is mainly transmitted by blood and semen, though there are other ways of transmission very similar to those of hepatitis B [1]. Besides AIDS, other clinical syndromes that are related to the HTLV-IΠ infection have been reported, e.g., transitory inapparent infection, prolonged lymphadenopathy syndrome, AIDS-related complex, and, with particular epidemiological importance, asymptomatic HTLV-III infection [2]. AIDS mainly attacks four risk groups: homosexual men, heroin addicts, hemophiliacs and Haitians [1]. Renal diseases in AIDS patients have been reported [3, 4], and simultaneously the incidence of renal illness is enhanced among heroin addicts by several causes [5]. The possibility that a patient with AIDS or, more probably, a HTLV-III carrier needs dialysis treatment must be kept in mind for the future. In the same way, it is possible that patients undergoing hemodialysis treatment who need multiple transfusions for anemia or preparation for renal transplantation acquire the infection, although the administered blood has been previously tested for anti HTLVIII antibodies. The risk of infection among the other patients on hemodialysis is high, especially if we consider the altered immune system of uremic patients [6]. In our experience, we have treated a 23-year-old male alcoholic and intermittent heroin abuser with a history of polyuria greater than 4 liters per day throughout his life who reached the endstage renal disease following chronic interstitial nephropathy, probably nephronoph-thisis. An arteriovenous fistule was made, and he was included in a hemodialysis program. After four sessions, Elisa test for anti HTLV-III antibodies proved positive, and the patient was removed from hemodialysis. A Tenckhoff catheter was inserted and the patient trained for continuous ambulatory peritoneal dialysis treatment. The WHO has advised the use of the same measures as employed in the prevention of hepatitis B for the prophylaxis of AIDS [7]. In hemodialysis units, these measures include periodic testing for hepatitis B infection of patients and staff, removing HBs antigen positive patients, assigning