Changing Electrolyte and Acido-Basic Profile in HIV-Infected Patients in the HAART Era

Abstract

Background: HIV-infected patients may develop a variety of underreported metabolic abnormalities that may be classified into HIVAN, specific HIV abnormalities, coincidental renal disorders and anti-retroviral-treatment-induced side effects. Methods: Our descriptive cross-sectional study evaluates the prevalence of electrolyte and acid base disorders in HIV patients in the HAART era in a tertiary care teaching hospital. All consecutive HIV-infected patients (n = 1,232) presenting at our Department of Infectious Disease over 3 months were included. Measurements: All available biochemical data obtained at admission or on the day of the visit were analyzed. We identified risk factors for electrolyte and acid base disorders with univariate regression analysis and multivariate stepwise regression analysis. Variables tested for significance included age, sex, absolute CD4 and CD8 counts, hepatitis B and C antibodies, and use and type of anti-retroviral medication. Results: Most frequent and clinically relevant abnormalities were hyperuricemia in 41.3%, hypophosphatemia in 17.2% and low bicarbonate level in 13.6% of HIV-tested patients. Plasma magnesium was out of the normal range in 38.9% and blood glucose in 25.3% of the tested patients. When CD4 count was below 200/mm³, 9.2% of tested patients experienced low serum calcium (vs. 0.5% if CD4 count >200/mm³, p < 0.002), 11.4% increased creatinine plasma level (vs. 2.3% if CD4 count >200/mm³, p < 0.0001) and 24.5% low serum bicarbonate (vs. 13.7% if CD4 count >200/mm³, p < 0.0001). Protease inhibitor treatment was a significant risk factor of hyperuricemia (p < 0.003). Non-nucleoside reverse transcriptase inhibitor therapy was significantly associated with less hyperuricemia (OR = 0.6, 95% CI 0.38–0.96) and with hypophosphatemia (OR = 2.0, 95% CI 1.1–3.4). Conclusions: The profile of biochemical abnormalities in HIV-infected patients has changed, hyperuricemia and hypophosphatemia being the most prevalent. Causes are poorly understood. Interpretation of drug-induced side effects in the HIV patient is only meaningful if performed versus a control group of patients.

Combination ART-Induced Oxidative/Nitrosative Stress, Neurogenic Inflammation and Cardiac Dysfunction in HIV-1 Transgenic (Tg) Rats: Protection by Mg

“…The proposed schematic steps of cART-induced neurogenic/oxidative inflammation under HIV-1 infection resulting in enhanced cardiac dysfunction, and the Mg protective mechanisms are summarized by Figure 11 (Graphic representation). In light of reports that blood SP levels were elevated in HIV-infected men [51] and women [52], and that a large subpopulation of HIV-1 infected individuals (~30%) also have co-existing hypomagnesemia [17,18,19,20,21], we state that our findings with HIV-1 transgenic rats indicate the significant clinical relevance of this model. Of equal importance, Mg-supplementation completely prevented the development of kidney dysfunction, lessened the elevations of circulating SP, and substantially protected against the cardiac dysfunction in both untreated and cART-treated Tg rats; these findings suggest a potential adjunct therapeutic role for Mg supplements during cART treatment of HIV patients.…”

“…Later clinical studies [19,20,21,22] further showed that HIV-1 infected patients treated with HAART displayed significantly lower circulating Mg in at least 1/3 of the patients, confirming the notions that both HIV infection and HAART treatment contributed in some way to excessive loss of Mg. However, the contribution to Mg loss from HIV-1 infection and from specific ART treatments was unclear.…”

Acute Kidney Injury in HIV-Infected Patients

“…A cross-sectional study including both ambulatory and hospitalized patients in Paris demonstrated a relatively low prevalence of hyponatremia, but identified a high frequency of other electrolyte abnormalities, including hypophosphatemia, low serum bicarbonate, and hyper- and hypomagnesemia. 29 Hyperkalemia, which may be associated with trimethoprim or pentamidine, 15 was rare in this population. Differences in the frequency of electrolyte abnormalities in this study may be related to improved control of HIV infection, with a mean CD4 cell count of 420 cells/mm 3 , but may also reflect the inclusion of a heterogenous population of ambulatory and acutely ill patients.…”

“…Differences in the frequency of electrolyte abnormalities in this study may be related to improved control of HIV infection, with a mean CD4 cell count of 420 cells/mm 3 , but may also reflect the inclusion of a heterogenous population of ambulatory and acutely ill patients. 29 Although the spectrum of electrolyte disorders has changed in the ART era, antiretroviral agents have also been associated with electrolyte disorders, including lactic acidosis observed with nucleoside reverse transcriptase inhibitors and proximal tubulopathy related to the nucleotide reverse transcriptase inhibitor tenofovir. 15 Antiretroviral nephrotoxicity is reviewed in detail elsewhere in this issue.…”

HIV associated hypocalcaemia among diarrheic patients in northwest Ethiopia: a cross sectional study

“…In addition, lactic acidosis [19], hypophosphatemia, [20], hypernatremia [21], and hypocalceamia [20,22] have also been described. In a recent study conducted by our group in northwest Ethiopia, hypercalcemia was widespread among asymptomatic HIV infected patients [23].…”