Abstract: Objective  To analyze the correlation between the infection after the arteriovenous fistula (AVF) surgery and the levels of peripheral blood CD4 count and albumin (ALB) in human immunodeficiency virus (HIV)-positive patients with renal failure undergoing hemodialysis.  Methods  A total of 96 patients with HIV-positive and renal failure primarily undergoing AVF surgery for hemodialysis at the Chengdu Public Health Clinical Medical Center from July 2016 to October 2023 were selected as the research subjects. They were divided into an infection group (20 cases) and an non-infected group (76 cases) based on whether they had AVF infection. Logistic regression was used to analyze the factors affecting the occurrence of infection after AVF surgery. Spearman correlation was used to analyze the correlation between peripheral blood CD4 count, ALB level, infection probability score (IPS), and acute physiology and chronic health evaluation II (APACHE II) score. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of peripheral blood CD4 count and ALB for the occurrence of AVF infection after the surgery.  Results  The repeated puncture rate and the rate of allergy at puncture site were 55.00% and 45.00% respectively in the infection group, higher than those of 19.74% and 14.47% respectively in the non-infection group (χ2=9.970 and 7.191; P=0.002 and 0.007). The peripheral blood CD4 count and ALB level were lower in the infected group than in the non-infected group (t=8.073 and 7.092; P=0.001 and 0.001). Repeated puncture at the puncture site (OR=3.552, 95% CI: 1.186～10.637, P=0.001), allergy at puncture site (OR=4.042, 95% CI: 1.245～13.120, P=0.001), peripheral blood CD4 count (OR=0.370, 95% CI: 0.182～0.753, P=0.001), and ALB level (OR=0.356, 95% CI: 0.176～0.720, P=0.001) were the factors affecting the occurrence of infection after the first AVF surgery in HIV-positive renal failure patients undergoing hemodialysis (P＜0.05). In the infection group, patients with CD4 count ＜200 cells/μl had higher IPS and APACHE II scores than those with CD4 count ≥200 cells/μl (t=3.774 and 4.123; P=0.001 and 0.001); patients with ALB ＜30 g/L had higher IPS and APACHE II scores than those with ALB ≥30 g/L (t=3.594 and 4.229; P=0.002 and 0.001); peripheral blood CD4 count and ALB level were negatively correlated with IPS and APACHE II scores  (r=-0.576,  -0.621,        -0.562 and -0.643 respectively; P=0.001, 0.001, 0.001 and 0.001 respectively). The area under the curves of peripheral blood CD4 count and ALB for predicting infection in HIV-positive renal failure patients undergoing hemodialysis after AVF surgery were 0.763 and 0.800 respectively; the area under the curve of combined use of peripheral blood CD4 count and ALB was 0.947, significantly greater than that of individual use of the two factors for the prediction (Z=2.793 and 2.078; P=0.007 and 0.035).  Conclusion  Infection after the first AVF surgery in HIV-positive renal failure patients is closely related to peripheral CD4 count and ALB level. Combined use of peripheral CD4 count and ALB level can provide an important reference to predict AVF infection.

Key words: Human immunodeficiency virus, Renal failure, Infection, CD4 count, Albumin