A ground-breaking national study on the nutritional status and quality of life of HIV-positive transplant recipients who received, or were candidates to receive, kidneys from HIV-positive donors earned Dr Claire Martin her PhD in Dietetics.

Chronic kidney disease (CKD) among the HIV positive population, arising largely from HIV-associated nephropathy (HIVAN), is on the rise in sub-Saharan Africa. With South Africa’s limited public dialysis resources, many HIV-positive patients need to be candidates for a kidney transplant to gain access to dialysis. While an HIV-positive status previously precluded patients from receiving kidney transplants, advances in recent years have demonstrated that they can successfully undergo kidney transplants. In these cases, only HIV-negative donors were used.

South Africa was the site of the first renal transplant involving an HIV-positive donor and recipient, widening the pool of available donors to offer recipient patients an increased chance of survival.

Martin explained that, in the general population, while transplantation extends survival, nutritional problems in both pre- and post-transplant patients present a threat to patient and graft survival as well as a patient’s quality of life. These health and nutritional risks are multiplied in the case of HIV-positive patients.

‘Nutrition has always formed an important part of patient care in both transplant patients and those with HIV,’ said Martin. ‘Nutrition therapy aims to minimise the effects of the disease, its complications, and the side effects of medication and optimise quality of life. Both dialysis and transplants are associated with nutritional concerns that carry morbidity and mortality risks.

‘Since nutritional health is a modifiable factor, improving nutritional status can positively influence graft and patient outcomes. However, to date, nutritional aspects in this group have remained unexplored,’ said Martin.

Against this backdrop, Martin assessed the nutritional status of kidney transplant candidates and recipients. She followed 76 participants in six provinces over a six-month period, conducting a series of body measurements, blood tests and questionnaires. Martin included health-related quality of life measures, gaining the patients’ perspectives on other aspects of health such as social, mental and psychological well-being.

This research contributes to current understanding of the physical and metabolic changes that may occur in pre- and post-kidney transplanted, HIV-positive patients and influence their nutritional health and quality of life. It also points to dietary and lifestyle factors that will optimise post-transplant nutritional status, assist in sustaining graft function, and delay the development of co-morbidities.

The study recommends that patients identified as at risk of clinical complications seek appropriate help based on the outcome of the assessments, in order to improve their health and quality of life. The results also provide a reference point to monitor future dietary interventions or conduct follow-up research.

Martin’s interest in HIV medicine and nutrition was sparked during her work as a dietitian at Northdale Hospital’s HIV outpatient clinic, and reports of kidney transplants at Groote Schuur Hospital that involved HIV-positive donors and recipients, pioneered by Dr Elmi Muller. She completed her BSc and Post-graduate Diploma in Dietetics at UKZN, before completing a masters at Stellenbosch University.

She said that, while undertaking a PhD was challenging, she believes the experience has improved all aspects of her life.

Martin described her PhD as a family affair, and thanked her family and children, Joshua and Cairenn, for their understanding. She acknowledged Muller and her transplant team at Groote Schuur for allowing her access to their “positive to positive” programme and making her research possible.

Martin also thanked her supervisor Dr Suna Kassier for her expertise, encouragement and academic and emotional support, as well as Professors Frederick Veldman and Demetre Labadarios for their mentorship. She acknowledged the National Research Foundation, Sugar Association of South Africa and the Halley Stott grant for making this national project possible.

Words: Christine Cuénod

Photograph: Abhi Indrarajan