Impact of Renal Transplantation on Psychosocial Status of HIV Positive Patients
Renal transplantation's impact on the psychosocial status of HIV positive patients is explored in this study. With the increased prevalence of end-stage renal disease in HIV positive individuals, understanding the effects of renal transplant on various aspects of their lives is crucial. The study aims to evaluate the quality of life, relationships, psychological well-being, financial aspects, and overall outlook of HIV positive patients post-renal transplant through a questionnaire-based assessment.
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Impact of Renal Transplantation on Psychosocial Status of HIV Positive Patients DR. Prof. D. K. AGARWAL MD,DM,DNB,MAMS,FICP,FISN Senior Consultant Nephrologist, Indraprastha Apollo Hospitals, New Delhi Phone: Mobile: +91-98112 00113 e-mail: dmas100@gmail.com
Introduction Combined Antiretroviral Therapy (cART) has transformed human immunodeficiency virus (HIV) into a chronic manageable infective condition since late 90s In this era, end stage renal disease (ESRD) has become one of important causes of morbidity and mortality J Global Infect Dis 2014;6:118-21
Introduction Nearly 4-7% of HIV positive patients demonstrate ESRD1 Patients infected with HIV require RRT once they reach CKD stage V HIV patient with ESRD on maintenance hemodialysis (HD) has poor CD4 recovery on ART compared with those who received renal transplant2 1 - AIDS 2003;17:1803-9 2 -Am J Transplant 2008;8 Suppl S2:177-336. Abstract 1.
Introduction They receive Hemodialysis in isolation with single use dialyzer that adds significant cost to their treatment, increasing their stress substantially Various retrospective analyses, case reports and small prospective studies data showed good patient and graft survival in HIV infected renal transplant patients Now renal transplants are successfully being carried out in HIV positive patients, with results at par with those of non HIV patients J Global Infect Dis 2014;6:118-21
Introduction However, impact of renal transplantation on psychosocial status in HIV positive patients is not available
Aim To study the impact of renal transplant on psychosocial status in HIV positive patients
Materials and methods HIV positive patients undergone renal transplants at our center were included Questionnaire was used to evaluate impact of renal transplantation on their psychosocial status Patients had to fill questionnaire Impact on quality of life, relationship, psychological status, finances and overall outlook was evaluated
Results Ten (10) HIV positive patients had received renal transplantation at our center and were included/participated in study n = 10 Male = 9 (90%) Female = 1 (10%) 1 Male Female 9
Results Impact on quality of life (A) Change of quality of life 9 8 8 7 6 All (n=10) patients quality of life became better 5 4 3 2 2 1 0 0 Better Much better Worse
Results Impact on quality of life (B) Ability to do job 10% Yes No 90% 90% subjects were able to do jobs Post Transplant
Results Impact on relationship (A) Behavior of Colleagues 5 5 4 4 3 2 1 1 0 Same as Pre-Tx Better than before Same as with non HIV persons Overall behavior of colleagues was better after renal transplant
Results Impact on relationship (B) Behavior of Spouse 4 Better 5 Same 0 Worse 1 Not Applicable 0 2 4 6 Overall behavior of spouses were better after renal transplant
Results Impact on relationship (C) Sexual relationship 4 4 3 3 2 2 1 0 1 0 Yes Yes Minor No Worse Not Marked difference Applicable Sexual relationship improved in 7 out of 9 patients (77%) as one patient loses life before transplant
Results Impact on Psychological status (A) Fear of unsuccessful Transplant 2 Yes 5 No To some extent 3 70% patients had fear concerning success of renal transplant at time of surgery
Results Impact on Psychological status (B) Desire to live 9 patients (out of 10) had desire for long life 1 patient (out of 10) did not had desire for long life (C) Depression 7 patients (out of 10) did not experienced depression while 1 patient had experienced and other 2 patients had experienced same to some extent * 90% patients wanted to live long, 70% did not experience depression at any point of time.
Results Impact on treatment related problems: (A) Fear of relapse of HIV after Transplant 6 6 4 4 2 0 Yes No Thus, 60% patients had fear of relapse after transfer, Actually no patient (0/10) experienced relapse after transplant
Results Impact on treatment related problems: Immunosuppression drugs calibration Frequently required in 7 (out of 10) patients while Remaining 3 patients had not required frequently calibration Change in HAART Protocol One patient required change in HAART protocol while remaining 9 patients had not required change in HAART protocol
Results Impact on treatment related problems: Increase in pill burden 1 No 9 Yes 0 5 10 90% patients had experienced increase in pill burden
Results Complications after transplantation 4 Infection Relapse 0 5 Impending feeling of rejection 2 DM 1 Gastric 2 No 0 1 2 3 4 5 6 * 50% patients expressed fear of graft rejection and 40% patient had infections.
Results Financial Impact Cost factor 7 7 6 5 3 4 3 0 2 1 0 Yes Yes Easily affordable unaffordable affordable with difficulty * All patients, 100% Considered cost as a major issue.
Results Impact on preventive aspects Measure to prevent CKD in HIV patient 9 9 8 7 * 90% patient that HAART Compliance is major factor in prevention of CKD in HIV patients. 6 5 3 4 3 1 2 1 0 CKD is inevitable in all HIV patients Low viral load is effective in preventing CKD HAART Compliance is effective in preventing CKD
Results Impact on outlook towards renal transplant as the modality of renal replacement therapy in HIV patients Renal Transplant is better modality of RRT then MHD No 10% Yes 90%
Results Factor limiting renal transplant in CKD stage-V 70% 80% 70% 60% 40% 20% 0% Unawareness Cost 70% each thought that high cost and unawareness are limiting factor
Results Measures to improve awareness for renal transplant in HIV positive patients in CKD stage-V 70% Doctors counseling about renal 50% Newspaper 60% Lectures 100% Counseling in HD unit 0% 20% 40% 60% 80% 100% Counseling of patients at dialysis centers (100%) and counseling of treating physician about RRT and renal transplant are best modalities to make transplant programme successful to common man
Important results All the patients experienced better quality of life post transplant 9 out of 10 were able to do their job normally Overall behavior of their colleagues and spouse was better after the transplant Sexual relationship improved dramatically in 7 out of 9 patients
Important results Impact of Renal transplant on psychological status was positive However fear concerning the success of the transplant was there in 70% patients at the time of surgery 60% patients had fear of relapse HIV infection due to immunosuppressive drugs Although none had relapse of the infection post transplantation
Important results By this time most patients understood the disease fairly well and 90% felt that compliance of cART could prevent / delay CKD in HIV patients 90% patients thought that renal transplant is the best modality of RRT However the huge cost involved and lack of awareness were important limiting factors
Important results Counseling of patients at dialysis centers as well as of physicians treating HIV patients about Renal Transplantation along with increasing awareness in Public by Newspapers and Lectures, were found to be the best way to make transplant programme successful to common man
Conclusions Renal transplantation has positive impact on psychosocial assessment in HIV positive patients Renal transplantation should be encouraged as treatment option whenever feasible in HIV positive ESRD patients
