by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
August 29, 2023
Shelton BA, Becker DJ, MacLennan PA, et al. Racial disparities in access to the kidney transplant waitlist among people with Human Immunodeficiency Virus. AIDS Patient Care STDs. 2023 Aug; 37(8):394-402. doi: 10.1089/apc.2023.0037. PMID: 37566535
Investigators sought to examine kidney transplant waitlist addition rates among adults with HIV, and also whether existing racial disparities in access to transplant waitlist persisted in the presence of an HIV diagnosis. Information related to demographic and clinical characteristics was retrieved from the U.S. Renal Data System, a national database of people with end-stage kidney disease which includes Medicare claims information. Patients with end-stage kidney disease entered the study (595,756 without HIV and 6,250 with HIV) and began contributing time-at-risk on the date of dialysis initiation, and were followed until the earliest of waitlist addition, death, living donor transplant before waitlist addition, or study conclusion on December 31, 2018. People with HIV were significantly younger, Black (70% vs. 26.7%), and less commonly female (31.7% vs. 43.4%). Rates of reported alcohol and drug dependance were higher among PWH (3.0% vs. 1.4%). After adjustment for demographic and clinical features as well as geography, HIV status and race were independently associated with a 50% and 12% lower likelihood of waitlist addition, respectively. Investigators also observed a significant interaction between HIV status and Black race, with hazard ratios revealing that Black PWH had lower predicted likelihood of waitlist addition than White patients with ESKD, White PWH, and Black patients with ESKD.
This national study is one of the first to specifically assess whether race and HIV intersect with regard to kidney transplant waitlist practices, and findings suggest that Black race and HIV status combined are associated with lower likelihood of waitlist addition than either Black race or HIV status independently. Given the disproportionate prevalence of HIV and kidney disease among Black populations, these findings highlight important opportunities for advocacy, collaboration, and information sharing for both provider and patient communities.
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