OUTCOME OF HIV-INFECTED PATIENTS OF PERITONEAL DIALYSIS: EXPERIENCE IN A CENTER AND LITERATURE REVIEW.
Evolución de los pacientes infectados por el VIH en diálisis peritoneal: experiencia de un centro y revisión de la literatura.
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Demographic  and  laboratory  data  of  all  patients were  reviewed. The  survival curve was calculated using  the Kaplan-Meier method. Patients who were switched to another replacement  treatment  modality  (HD  or  kidney  transplant) were  considered  lost  for outcome purposes. Outcomes were compared using a Student¿s t test for paired data. Means and medians  are  given  with  their standard  deviation  and  range respectively. A value of p < 0.05 was considered statistically significant. <br></br><br></br>RESULTS <br></br><br></br>Eight patients, seven males and one female, were included in this  period. All  patients were  Caucasian. Mean  patient  age was  40,7 ± 5,3  years. The  different  underlying  diseases  are given in Table 1. Six patients had stage C3 HIV infection, one stage B3, and  the other  stage B2 HIV infection. Serological testing for HCV was positive in all patients, but only one pa- tient had data suggesting chronic liver disease. They all were former intravenous drug users. <br></br><br></br>Mean  follow-up  time  on  PD  was  41.2  ± 32,1  months, with  a  median  of  29,5  months  (range:  12-103).  Survival rates at one,  two, and  three years were 100%, 62.5%, and 50% respectively, as may be seen in Figure 1, with an overall mortality at study end of 62.5%. Five patients died, two from ischemic heart disease, a third patient from fulminant gangrene in his right leg caused by Pseudomonas aeruginosa,  a  fourth  patient  died  at  home  for  an  unknown  reason, and  the  final  patient  died  from  sclerosing  peritonitis  after six years on PD. A patient was switched to HD after peritonitis  induced by Mycobacterium fortuitum, another patient received a kidney transplant after 9 years on dialysis, and a final patient continued on PD at study completion (table I). Table II compares the survival rates reported by studies involving HIV patients on peritoneal dialysis, showing an increased  survival  and  a  decrease  in  complications  over  the years. <br></br><br></br>Complications of the procedure <br></br>The infectious peritonitis (IP) rate and the number of hospitalizations were 0.36 IP/year and 0.69 admissions/year respectively. Staphylococcus epidermidis was the most common causative organism, but was only found in two patients. A patient experienced  six  IP episodes  (two  from  Klebsiella pneumoniae,  two from Staphylococcus epidermidis, one sterile peritonitis, and one from Pseudomonas fluorescens). Another patient  experienced  an  IP by  Mycobacterium fortuitum that required  removal of his peritoneal catheter and  switching  to HD. In another case with a good outcome, the identified germ was  Escherichia coli,  and  IP induced  by Candida albicans occurred in a single case. Three patients suffered no peritonitis during this study period, one of them probably because of his short time on PD (12 months). A second patient continues on PD after 32 months, and the remaining patient received a kidney transplant after almost nine years on PD. Only 15.7% of hospital admissions were caused by an infectious peritonitis. The most common  reason  for admission was  respiratory tract infection. <br></br><br></br>Course of HIV infection <br></br>All patients were on antiretroviral therapy. Although different schemes were  used,  all  patients  but  one were  on  triple  therapy.  Among  nucleoside  reverse  transcriptase  inhibitors (NRTIs), the most commonly used drug was lamivudine (Epivir®) taken by 75% of patients. Thus, the most usual combination consisted of lamivudine plus stavudine (Zerit®), found in half the cases. These drugs were normally associated to a protease  inhibitor  (PI).  Both  stavudine  and  abacavir  (Ziagen®) were taken by 62.5% of patients. The most commonly used PI was  nelfinavir  (Viracept®),  received  by  37.5%  of  patients. Non-nucleoside  reverse  transcriptase  inhibitors (NNRTIs) were  scarcely used, and only one patient  received efavirenz (Sustiva®)  in his  treatment. From  the clinical viewpoint, patients maintained a good viral response. None of the five patients with an undetectable viral  load experienced any changes in viral load, that decreased to undetectable levels in the other  three patients. CD4  levels  increased  in all patients but one. Mean CD4 percentage was 20.2% at baseline and 23.5% at one year, but this increase was not statistically significant. Another aspect assessed was weight gain (net weight), based on  the  assumedly  greater malnutrition  in PD  due  to  protein loss in peritoneal fluid. No differences were found in our patients  in  serum  albumin  levels  or  nPCR,  but  a  significant weight gain was  seen  in  the  first year. Mean patient weight was 60.6 ± 8 kg at baseline and 64.9 ± 10 kg at one year, p = 0.016 (fig. 2). <br></br><br></br>DISCUSSION <br></br><br></br>Our  study  confirms  an  increased  survival  of HIV patients on peritoneal dialysis. Survival rates at one, two, and three years were similar to another recent study3 and higher than the rates reported by Tebben and Kimmel.5,6 Early studies on HIV patients  with  end-stage  renal  disease  (ESRD)  and renal  replacement  therapy  by  Ortiz,8 Perinbasekar,9  and Feinfeild10 reported a poor outcome. New highly active antiretroviral  therapy  (HAART)  has  led,  particularly  since 1995,  to  a marked  increase  in  life  expectation1 which  has allowed for survival rates in peritoneal dialysis longer than 5  years,  and  up  to  9  years  in  our  experience.3 However, mortality  continues  to  be  high  in  these  patients  despite more  effective  treatments.3,4 Survival  of  HIV-infected  patients  has  improved,1 and  does  not  change  irrespective  of the  renal  replacement  therapy  used.7 Rodríguez  et  al,  in <br></br>their study on 100 HIV-infected patients, showed that those who  started  dialysis  in  the  pre-HAART era  survived  9.4 months, while patients starting dialysis  in  the HAART era survived 16.1 months. However, the corresponding figures for all HIV-positive patients not on dialysis were 16 and 81 months.11 Other studies suggested an inadequate antiretroviral treatment in patients on renal replacement therapy.12 However,  an  analysis  of  the  different  studies  involving HIV-infected  patients  on  PD  showed  an  improved  survival, particularly when the two pre-HAART studies were compared  to  studies  conducted  in  the HAART era,  from  a mean survival of 17.9 months to longer than 40 months (table II). <br></br><br></br>From  the  therapeutic  viewpoint,  there  are  studies  and guidelines with recommendations for antiretroviral therapy in ESRD  and  dialysis,  but ART in PD  is  not  clearly  defined.13 Szczech reviewed  this aspect  in 89 HIV-positive patients,  five  of  them  on PD,  and  found  that  the most  commonly used drug was  lamivudine,  in 36 patients,  followed by  stavudine  in  33  patients  and  nelfinavir  in  21  patients. These results were similar to those seen by our study group. These data are consistent with the widespread use of stavudine and nelfinavir during  the  final 90s and  the beginning of  the  2000  decade,  the  period  mostly  described  in  our study. These drugs are now used as first-line treatment because  of  their  low  potency  (nelfinavir)  or  high  associated toxicity  (stavudine).14,15 Currently,  and  until  studies  providing new indications are available, it appears reasonable to <br></br>take the same measures as in hemodialysis, considering the special characteristics of these patients on PD.16,17 <br></br><br></br>Complications of  the procedure have decreased  in parallel  to  the  increase  in  survival. Thus,  infectious peritonitis rates in HIV patients have decreased from 3.9 and 2.4 episodes/year  in  early  studies  to  1.4  episodes/year  in  the Khana  study  or  0.3  episodes/year  in  our  study,4.6 though some  studies have  reported  conflicting  results. Thus, Tebben et al6 found  in a group of 39 patients a higher number of peritonitis  in HIV-infected patients, and Scholoth18 also noted in 9 similar patients a higher rate of infectious peritonitis, as did Khana.4 Other  authors  showed  no  differences between  both  groups.5,19 In  our  study,  peritonitis  rate was <br></br>not different from the rate seen in non-HIV-infected population in our unit. <br></br><br></br>Although opportunistic  infections have been  reported  in HIV patients  treated with PD, Gram-positive cocci are  the most  common  cause  of  infectious  peritonitis.6,20-22 Our  results are very similar to those of the Kimmel group, with a case  each  of  IP caused  by  Pseudomonas and Mycobacterium. Fungal involvement was seen in a single patient, and there were no cases of polymicrobial peritonitis. 23 It should be noted that 6 of the 10 episodes of peritonitis occurred in the same patient, and three patients experienced no IP while on  peritoneal  dialysis,  in  contrast  to  other  studies  where 100% of patients experienced some episode of  IP.5 Course of peritonitis in our study was usually favorable, and removal  of  peritoneal  catheter was  only  required  in  two  cases. Hospitalization  rate was also  low as compared  to previous studies.3-4 <br></br><br></br>These results are possibly conditioned by advances in antiretroviral therapy, a decreased viral load, and an improved immune status, which are known good prognostic factors.24-26 In our study, all patients were on HAART, viral load was low or undetectable in most cases, and the CD4 percentage was  adequate. Although higher  serum  albumin  levels3 and an  increased  risk  of  peritonitis  associated  to  them27 have been  reported  in  PD,  this  does  not  appear  to  result  in  a lower survival in HIV patients.5 While no changes in serum albumin  levels or nPCR were  found  in our patients, an  increase  in  net  weight  was  shown,  at  least  during  the  first year. However,  62%  of  patients were  hypertensive  at  PD start,  and  two  patients  died  from  coronary  disease.  Some drugs, such as lopinavir, have been associated to an increase  in  systolic blood pressure,28 other drugs  such as  fosamprenavir29 to a lipid-lowering effect, and still others such as ritonavir  have  been  associated  to  both  effects.30 NNRTIs and PIs usually have a poorer lipid profile and a higher risk of  associated  coronary disease.31-33 Association of  risk  factors may be determinant for a decreased overall survival in these patients. <br></br><br></br>On  the other hand,  increased prevalence of  these patients raises therapeutic alternatives that were unthinkable not long ago. Thus, kidney transplant is a valid option if the following requirements are met: HAART, undetectable viral load, CD4 count above 200 cells/mm3, and absence of recent opportunistic  infections.25,34,35 In  our  case,  a  patient meeting  the  above criteria received a kidney transplant with an excellent outcome. Long-term outcome in these kidney transplant patients is unknown, but  short and mid-term course appears  safe, or at least with a similar survival to other risk groups.36,37 <br></br><br></br>In conclusion, while our study has the limitations inherent to a retrospective study on a small patient sample, it showed  an  improved  survival  and  low  rates  of  infectious peritonitis and hospitalization. Adequate  treatment of HIV infection  and  other  associated  diseases  conditions  the  current outcome of the procedure, which is similar to the non-HIV population in our study. Immune status does not appear to change in PD, and adequate nutrition is possible. PD is therefore a treatment of choice for these patients. Until greater experience and additional studies are available, individualized  and multidisciplinary  control  appears  reasonable in these patients. <br></br>" "pdfFichero" => "P-E-S-A355-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440655" "palabras" => array:1 [ 0 => "Antirretrovirales" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440657" "palabras" => array:1 [ 0 => "Peritonitis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440659" "palabras" => array:1 [ 0 => "Diálisis peritonel" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440661" "palabras" => array:1 [ 0 => "VIH" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440663" "palabras" => array:1 [ 0 => "Supervivencia" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440656" "palabras" => array:1 [ 0 => "Antiretroviral therapy" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440658" "palabras" => array:1 [ 0 => "Peritonitis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440660" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440662" "palabras" => array:1 [ 0 => "HIV" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440664" "palabras" => array:1 [ 0 => "Survival" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "La supervivencia de los pacientes VIH ha mejorado en los últimos años. Secundariamente la necesidad de tratamiento renal sustitutivo en estos pacientes también ha aumentado. Su pronóstico en diálisis así como las complicaciones asociadas han mejorado desde los primeros casos descritos. Mostramos los pacientes VIH incluidos en nuestra unidad de diálisis peritoneal desde noviembre-95 hasta noviembre-07. Fueron 8 pacientes, con una edad media de 40,7 ± 5,3, con un tiempo de seguimiento de 41,2 ± 32,1 meses (rango 12-103). Las etiologías de la IRC fueron diabetes mellitus tipo 1 (2), glomérulo-esclerosis focal y segmentaria (2), nefropatía IgA (1) y no filiada (3). El 62,5% de los pacientes eran hipertensos. La supervivencia al año, dos y tres respectivamente fue de 100, 62,5 y 50%. La mortalidad total fue del 62,5% al finalizar el estudio. La causa principal de deceso fueron los eventos cardiovasculares (2 pacientes, 25%). La tasa de peritonitis y el número de admisiones fue de 0,36 paciente/año y de 0,69 ingresos/año respectivamente. El Estafilococo epidermidis fue la principal causa de peritonitis infecciosa y la infección respiratoria el motivo más frecuente de hospitalización. Todos los pacientes recibían tratamiento antirretroviral (TARV). La lamivudina, la estavudina y el nelfinavir fueron los más habituales en el tratamiento. Durante el primer año en diálisis peritoneal se pudo evidenciar que la carga viral y el porcentaje de CD4 no se modificaba. Al mismo tiempo se constató un aumento del peso en el primer año (60,6 kg vs 64,9 kg, p = 0,016). Nuestros resultados sugieren que la DP puede ser una técnica de elección en estos pacientes. La supervivencia ha aumentado y las complicaciones asociadas a la técnica de DP también son menores. La importancia de otros factores de riesgo, como los cardiovasculares no está definida. Por el momento la individualización de cada paciente y un trabajo multidisciplinario son obligados." ] "en" => array:1 [ "resumen" => "Overall survival of HIV-infected has increased over the last ten years. In parallel a higher need for renal replacement therapy (RRT) in this population has been more observed. RRT associated complications and outcomes greatly varied since the introduction of highly active antiretroviral therapy (HAART) and scarce data is available regarding the outcome of peritoneal dialysis (PD) in HIV-infected patients under HAART. We described 8 HIV-infected patients who were admitted at the Peritoneal Dialysis Unit at our institution from november-95 to november-07. Mean age was 40.7 ± 5.3. Causes of end-stage renal disease were diabetes mellitus type 1 (2), focal and segmental glomerular sclerosis (2), IgA nephropathy (1) and unknown origin (3). High blood pressure was detected in 62,5 % of the patients. Mean follow-up was 41.2 ± 32.1 months (range 12-103). One, two and three year survival was 100, 62.5 and 50% respectively. Overall mortality was 62.5% and cardio-vascular events were the main cause of death (2 patients, 25%). Infective peritonitis rate was 0.36 IP/year, and Staphylococcus epidermidis was the most common pathogen identified. Hospital admission rate was 0.69 admission/year and the main cause of admission was respiratory tract infecction. All patients received HAART. Lamivudine, stavudine and nelfinavir were the most frequent treatment prescribed. During the first year in PD undetectable viral load and CD4% were not modified. A significant weight gain was observed during the first year of the study (60.6 kg vs 64.9 kg, p = 0.016). Our results suggest that PD is a suitable choice for RRT in HIV-infected. Compared to previous studies, an increase in overall survival and a decrease in PD-associated complications were seen. The significance of cardio-vascular risk factors in the outcome of PD in HIV-infected patients is not completely determined. A multidisciplinary aproach and a management of patients in individual basis remains mandatory." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1\u{A0} Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853-60." 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Enferm Infecc Microbiol Clin. 2005 Jun-Jul;23(6):363-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15970170" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "36 Mazuecos A, Pascual J, Gómez E, Sola E, Cofán F, López F, Puig-Hooper CE, Baltar JM, González-Molina M, Oppenheimer F, Marcén R, Rivero M. Trasplante renal en pacientes con infección HIV en España. Nefrologia. 2006;26(1):113-20." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "37 Wyatt CM, Murphy B. Kidney transplantation in HIV-infected patients. Semin Dial. 2005 Nov-Dec;18(6):495-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16398712" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002800000005/v0_201502091635/X2013251408003979/v0_201502091635/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002800000005/v0_201502091635/X2013251408003979/v0_201502091635/en/P-E-S-A355-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408003979?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 6 | 14 |
| 2024 October | 36 | 56 | 92 |
| 2024 September | 54 | 37 | 91 |
| 2024 August | 92 | 62 | 154 |
| 2024 July | 113 | 28 | 141 |
| 2024 June | 46 | 39 | 85 |
| 2024 May | 57 | 41 | 98 |
| 2024 April | 56 | 32 | 88 |
| 2024 March | 33 | 25 | 58 |
| 2024 February | 42 | 50 | 92 |
| 2024 January | 25 | 26 | 51 |
| 2023 December | 26 | 26 | 52 |
| 2023 November | 42 | 34 | 76 |
| 2023 October | 27 | 32 | 59 |
| 2023 September | 35 | 32 | 67 |
| 2023 August | 23 | 24 | 47 |
| 2023 July | 37 | 48 | 85 |
| 2023 June | 38 | 28 | 66 |
| 2023 May | 43 | 42 | 85 |
| 2023 April | 15 | 19 | 34 |
| 2023 March | 29 | 24 | 53 |
| 2023 February | 19 | 18 | 37 |
| 2023 January | 32 | 27 | 59 |
| 2022 December | 46 | 28 | 74 |
| 2022 November | 34 | 31 | 65 |
| 2022 October | 39 | 40 | 79 |
| 2022 September | 44 | 41 | 85 |
| 2022 August | 31 | 37 | 68 |
| 2022 July | 36 | 51 | 87 |
| 2022 June | 29 | 42 | 71 |
| 2022 May | 32 | 31 | 63 |
| 2022 April | 29 | 35 | 64 |
| 2022 March | 39 | 59 | 98 |
| 2022 February | 29 | 45 | 74 |
| 2022 January | 34 | 31 | 65 |
| 2021 December | 40 | 36 | 76 |
| 2021 November | 42 | 50 | 92 |
| 2021 October | 35 | 47 | 82 |
| 2021 September | 30 | 34 | 64 |
| 2021 August | 32 | 37 | 69 |
| 2021 July | 31 | 38 | 69 |
| 2021 June | 23 | 34 | 57 |
| 2021 May | 50 | 28 | 78 |
| 2021 April | 218 | 66 | 284 |
| 2021 March | 77 | 36 | 113 |
| 2021 February | 72 | 16 | 88 |
| 2021 January | 32 | 12 | 44 |
| 2020 December | 39 | 31 | 70 |
| 2020 November | 28 | 16 | 44 |
| 2020 October | 19 | 23 | 42 |
| 2020 September | 20 | 6 | 26 |
| 2020 August | 27 | 11 | 38 |
| 2020 July | 39 | 18 | 57 |
| 2020 June | 46 | 23 | 69 |
| 2020 May | 42 | 10 | 52 |
| 2020 April | 32 | 22 | 54 |
| 2020 March | 36 | 10 | 46 |
| 2020 February | 50 | 25 | 75 |
| 2020 January | 72 | 17 | 89 |
| 2019 December | 40 | 29 | 69 |
| 2019 November | 46 | 26 | 72 |
| 2019 October | 41 | 15 | 56 |
| 2019 September | 22 | 19 | 41 |
| 2019 August | 18 | 15 | 33 |
| 2019 July | 36 | 23 | 59 |
| 2019 June | 27 | 12 | 39 |
| 2019 May | 19 | 14 | 33 |
| 2019 April | 61 | 32 | 93 |
| 2019 March | 21 | 14 | 35 |
| 2019 February | 21 | 14 | 35 |
| 2019 January | 30 | 15 | 45 |
| 2018 December | 59 | 28 | 87 |
| 2018 November | 67 | 14 | 81 |
| 2018 October | 49 | 21 | 70 |
| 2018 September | 50 | 14 | 64 |
| 2018 August | 38 | 18 | 56 |
| 2018 July | 41 | 16 | 57 |
| 2018 June | 36 | 11 | 47 |
| 2018 May | 36 | 18 | 54 |
| 2018 April | 29 | 5 | 34 |
| 2018 March | 35 | 9 | 44 |
| 2018 February | 33 | 6 | 39 |
| 2018 January | 24 | 3 | 27 |
| 2017 December | 36 | 11 | 47 |
| 2017 November | 29 | 8 | 37 |
| 2017 October | 26 | 6 | 32 |
| 2017 September | 35 | 11 | 46 |
| 2017 August | 33 | 5 | 38 |
| 2017 July | 38 | 10 | 48 |
| 2017 June | 34 | 9 | 43 |
| 2017 May | 54 | 16 | 70 |
| 2017 April | 29 | 19 | 48 |
| 2017 March | 12 | 15 | 27 |
| 2017 February | 29 | 9 | 38 |
| 2017 January | 16 | 9 | 25 |
| 2016 December | 37 | 5 | 42 |
| 2016 November | 42 | 12 | 54 |
| 2016 October | 66 | 10 | 76 |
| 2016 September | 78 | 4 | 82 |
| 2016 August | 156 | 12 | 168 |
| 2016 July | 105 | 10 | 115 |
| 2016 June | 87 | 0 | 87 |
| 2016 May | 105 | 0 | 105 |
| 2016 April | 74 | 0 | 74 |
| 2016 March | 81 | 0 | 81 |
| 2016 February | 72 | 0 | 72 |
| 2016 January | 75 | 0 | 75 |
| 2015 December | 101 | 0 | 101 |
| 2015 November | 66 | 0 | 66 |
| 2015 October | 62 | 0 | 62 |
| 2015 September | 78 | 0 | 78 |
| 2015 August | 66 | 0 | 66 |
| 2015 July | 70 | 0 | 70 |
| 2015 June | 34 | 0 | 34 |
| 2015 May | 53 | 0 | 53 |
| 2015 April | 5 | 0 | 5 |
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