Human immunodeficiency virus (HIV)-infected hemodialysis (HD) patients have a very high morbidity and mortality. Reports from the last few years have suggested that highly active antiretroviral therapy (HAART) has remarkably improved the survival of HIV-infected patients. To determine whether the beneficial effects of HAART have also extended to HIV-infected HD patients, we retrospectively evaluated the survival of all HIV-infected patients who underwent chronic maintenance HD between 1992 and 1999 at our institution. Twenty-two HIV-infected patients were started on chronic maintenance HD at our institute during this period. The mean age of the patients was 36 +/- 9 (SD) years (range, 21 to 58 years). Seven patients were treated with only one or two antiretroviral drugs (patients 1 and 5 were administered two antiretroviral drugs), and the remaining 15 patients were treated with HAART (three antiretroviral drugs or more). Fifty-seven percent (4 of 7 patients) of the patients on suboptimal therapy died after a mean time on HD therapy of 13 +/- 10 months compared with only 20% (3 of 15 patients) of those on HAART after a mean period on HD therapy of 28 +/- 17 months. Plasma viral load was significantly less in patients on HAART compared with patients on suboptimal therapy (3.35 +/- 0.92 versus 4.63 +/- 1.3 log(10) copies/mL; P = 0.03). Patients with diagnoses other then HIV-associated nephropathy and those on HAART had statistically longer survival times (P = 0.02 and P = 0.04, respectively). We conclude that HAART is successful in suppressing viral load in HIV-infected HD patients, and the survival of HIV-infected HD patients on HAART is better than that of patients on suboptimal antiretroviral therapy.