A Rare Mechanism of Hyponatremia in HIV Disease

Madariaga, Hector; Kumar, Aswini; Khanna, Apurv

doi:10.12659/ajcr.894299

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…Renal interstitial involvement may result in a salt-losing nephropathy. These may alter urine osmolality in a setting of low CD4 cells count [37]. These, however, were not observed in our study subjects.…”

Section: Discussioncontrasting

confidence: 57%

Factors of Low CD4 Cells Count in Treatment-naïve HIV Subjects in Southeast Nigeria

Anyabolu¹

2017

J AIDS Clin Res

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Background and objectives: Human immunodeficiency virus (HIV) infection is a global healthcare problem. Low CD4 cells count, an index of immunosuppression, is associated with escalating activity and progression of HIV infection. The factors which influence low CD4 cells count have not been completely identified nor are they evaluated in routine clinical practice. The aim of this study was to determine the prevalence of low CD4 cells count and to evaluate the factors which might influence immunosuppression in treatment-naïve HIV subjects in Southeast Nigeria.Methodology: This was a cross-sectional study involving treatment-naïve HIV subjects. Anthropometric and demographic data were obtained and CD4 cells count and other relevant investigations performed. The data were compared between those who have low CD4 cells count, defined, here, as CD4 <200 cells/ml, and those with CD4 ≥ 200 cells/ml. Potential risk factors of low CD4 cells count were determined. Results:The mean age of the subjects was 39+11 years. Females were made up 283 (72.0%) and males 110 (28.0%). The median value of the CD4 cells count was 391. Low CD4 cells count was prevalent in 49 (12.5%) of the subjects. There was significant association between CD4 cells count and body mass index (df=2, p=0.017), as well as serum low density lipoprotein cholesterol (df=1, p=0.027) and anemia (df=3, p=0.025). Significant, but poor, correlation was observed between CD4 cells count and 24 h urine protein (r=-0.117, p=0.023), creatinine clearance (r=-0.122, p=0.018), as well as hemoglobin (r=0.224, p<0.001). Creatinine clearance was a predictor of low CD4 cells count, p=0.001. Conclusion:The prevalence of low CD4 cells count was high in this study. Abnormal weight, dyslipidemia and proteinuric renal damage were common among treatment-naïve subjects who have low CD4 cells count. referrals from the neighboring states. Owerri, where the hospital situates, has a local municipal population of about 125,337, whereas the state population is conservatively put at 3,927,563 [18].The criteria for inclusion in this study were age range of 16-65 years and treatment-naïve HIV-positive status. Pregnancy, adrenal disease, renal or terminal illness and malignancy were the exclusion criteria. From each of the study subjects, informed written consent was obtained. The Ethics Committee of the hospital gave approval for the study.From each of the subjects anthropometric and demographic data were obtained with the aid of a questionnaire administered by our laboratory technicians who explained to them the aim of the study. The place of domicile and origin, gender and age of the subjects were obtained. Weight and height were taken and BMI rendered as weight/ height 2 (kg/m 2 ). Blood pressure was measured [19].Clear instructions were given to all the subjects on how to collect 24 h urine sample. For each subject, a day-time random spot urine sample and blood samples were collected at the end of the 24 h urine sample collection [19][20][21].From the random spot urine samples coll...

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Section: Discussioncontrasting

confidence: 57%

Factors of Low CD4 Cells Count in Treatment-naïve HIV Subjects in Southeast Nigeria

Anyabolu¹

2017

J AIDS Clin Res

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“…Hyponatremia in HIV disease and AIDS occur in 20-80% of hospitalized patients. A syndrome of inappropriate ADH secretion, volume depletion, and adrenal insu ciency, as well as some drugs, are the most common causes of hyponatremia in HIV-infected patients [15].…”

Section: Discussionmentioning

confidence: 99%

Typhoid Fever Complicated with Bowel Perforation in an HIV Patient

Karunathilake¹,

Jayalath²,

Abeygunawardena³

et al. 2021

Preprint

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Background Patients with HIV infection often develop multiple complications and comorbidities, including malignancies and opportunistic infections. The association of HIV infection with typhoid fever remains unclear, though there is a clear risk of typhoid in HIV infected persons. Therefore, the diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea. Case Presentation A 38-year-old gentleman presented with fever with significant weight loss and anorexia for eight months. He had worked abroad in a middle east country and had recently returned to Sri Lanka. On examination, he was thinly built with a BMI of 18 kg/m2. The initial full blood count revealed lymphopenia, anaemia and thrombocytopenia. He also had mild hyponatremia. His HIV Ag/Ab combo assay became positive, and he was found to have a low CD4 count. While on antiretroviral therapy, he developed nausea, vomiting and diarrhoea while continuing the preexisting fever followed by severe dyspnoea and epigastric pain and tenderness associated with tachypnoea, tachycardia and hypotension. The urgent chest X-ray revealed gas under the diaphragm. An urgent exploratory laparotomy was done, and he was found to have distal ileal perforation with a typhoid ulcer which was histologically confirmed later. During the postoperative period, the patient developed severe pneumonia, scummed despite all the resuscitation care given. Conclusion Fever in HIV patients could be due to HIV itself, opportunistic infections or malignancies. The diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea, constipation or bowel perforation. Salmonella typhi infection in HIV/AIDS patients may cause life-threatening complications, where the case fatality rate of typhoid significantly increase when present concurrently with HIV, and the mortality further increases with delayed diagnosis.

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“…These recent studies suggest decreased cortisol breakdown among critically ill patients as the main contributing factor to elevated cortisol levels and there is need for a well-designed and large sample size research to explore early diagnosis, optimal evaluation and treatment of adrenal insufficiency in critically ill patients. 11 In patients with HIV/AIDS, AI is one of the common endocrine manifestation and in developing countries, almost half of these newly diagnosed HIV and hospitalized HIV patient with advanced disease have AI and majority of these patients also have TB/HIV coinfection. 12 With almost 50% prevalence of adrenal insufficiency in patients with advanced HIV disease, it is worrisome that adrenal insufficiency diagnosis and evaluation is neglected in these patients that poses a major contributing factors in morbidity and mortality in this population.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Adrenal Insufficiency Among Patients of Human Immunodeficiency Virus

Shahid

Aftab

Kataria³

et al. 2021

Pak Postgrad Med J.

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Background: Human immunodeficiency virus (HIV) has emerged as a major public health problem worldwide over the last two decades. Many complications and problems are associated with HIV like lipodystrophy, retarded growth in young patients, impaired endocrine and renal functioning and cardiovascular diseases. Objective: To determine the frequency of adrenal insufficiency among patients of human immunodeficiency virus presenting to HIV clinic in a tertiary care hospital. Study Design: Cross Sectional Study. Setting: HIV clinic, Jinnah Hospital Lahore. Study Duration: August, 2019 to February, 2020. Material and Methods: A total of 180 patients of HIV presenting to HIV clinic of Jinnah hospital Lahore and fulfilling the selection criteria were approached after approval from ethical review board an informed consent was taken from the subject and an ACTH stimulation test was performed and adrenal Insufficiency was diagnosed. Intramuscular injection of 0.25 mg of synthetic ACTH was administered to all patients; and after 60 minutes serum cortisol was measured. A peak stimulated cortisol of less than 20 mcg/dl was labeled as adrenal insufficiency. Results: Mean and standard deviation of the age was 42.16 ± 17.31 years. Male patients were 56.1% while female patients were 43.9%. Adrenal insufficiency was present in 38.3% patients while it was absent in 61.7% patients. No significant association found between age and presence of adrenal insufficiency (p=0.280). Also no significant association found between duration of disease and adrenal insufficiency (p=.557). There was a significant association found between intake of antiretroviral therapy and presence of adrenal insufficiency having (p<0.005) Conclusion: Adrenal insufficiency was found in significant number of HIV patients but effect modifiers like age, duration of disease did not show significant association except intake of antiretroviral therapy.

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A Rare Mechanism of Hyponatremia in HIV Disease

Cited by 6 publications

References 13 publications

Factors of Low CD4 Cells Count in Treatment-naïve HIV Subjects in Southeast Nigeria

Factors of Low CD4 Cells Count in Treatment-naïve HIV Subjects in Southeast Nigeria

Typhoid Fever Complicated with Bowel Perforation in an HIV Patient

Frequency of Adrenal Insufficiency Among Patients of Human Immunodeficiency Virus

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