Moderate/Severe hyponatremia increases the risk of death among hospitalized Chinese human immunodeficiency virus/acquired immunodeficiency syndrome patients

Correlation between Hyponatremia and Cluster of Differentiation 4 in Response to Highly Active Antiretroviral Therapy Treatment in Patients with Human Immunodeficiency Virus Cerebral Toxoplasmosis

BACKGROUND: The proportion of HIV patients with hyponatremia was significantly higher in hospital compared to those without hyponatremia. HIV patients with hyponatremia had significantly lower CD4 cell counts, about twice the HIV viral load and an approximately four-fold higher prevalence. Hyponatremia was positively correlated with a decrease in CD4 cell count. AIM: The aim of this study was to determine the correlation between hyponatremia and CD4 cells in response to HAART treatment in patients with HIV cerebral toxoplasmosis. METHODS: The design of this study was correlative analytic with retrospective data collection method with secondary data sources obtained from the medical records of HIV-toxoplasma cerebral patients with hyponatremia at Haji Adam Malik Hospital Medan who met the inclusion and exclusion criteria and were included in this study. The research started from December 2021 to January 2022. RESULT: This study was conducted on 30 samples of medical records consisting of 24 males and six females with a mean (min-max) age of 36.1 (23–53). There were 28 subjects (83.3%) with an effective response to treatment and two subjects (6.6%) with a less effective response to treatment. There was a significant correlation between hyponatremia and CD4 cells in response to HAART treatment (p < 0.005; r = 0.0462). There was a significant correlation between hyponatremia and CD4 cell count before receiving HAART treatment (p < 0.005; r = 0.0526). CONCLUSION: There is a significant correlation between hyponatremia and CD4 cells in response to HAART treatment in patients with HIV cerebral toxoplasmosis.

Serum electrolytes and renal alterations in HIV-seropositive Mexican subjects

To examine potential risk factors associated with biochemical alterations in renal function in a population diagnosed with HIV/AIDS undergoing antiretroviral treatment.This is an observational, transversal, and relational design study that included 179 HIV-seropositive subjects. Glucose serum, cholesterol, triglycerides, total proteins, albumin, creatine, urea, blood urea nitrogen (BUN), and electrolytes levels were determined for each individual. Renal function was evaluated through the glomerular filtration rate (GFR), using the CKD-EPI equation. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate  < 60 mL/min/1.73 m2. Univariate model significant variables, with a 95% confidence interval (CI), were included in a multivariate logistic regression analysis.CKD prevalence in patients was 7.3%, with comorbidities of 7.8% for type 2 diabetes mellitus, 7.3% for arterial hypertension, and 35.2% for dyslipidemia. Additionally, both hypernatremia and hypophosphatemia were detected in 57% (n = 102) of the patients. Multivariate logistic regression suggested that CD4+ T cell count < 200 (P = .02; OR 0.2; CI 95% 0.08-0.8) was associated to hyponatremia; similarly, detectable viral load was associated to hypokalemia (P = .02; OR 5.1; CI 95% 1.2-21.3), hypocalcemia (P = .01; OR 4.1; CI 95% 1.3-12.3), and hypermagnesemia (OR 3.9; CI 95% 1.1-13.6). Patient age was associated to both hypophosphatemia (P = .01; OR 2.4; CI 95% 1.1-5.0) and hypermagnesemia (P = .01; OR 2.8; IC 95% 1.1-7.0), and high creatinine levels were associated to nucleoside reverse transcriptase inhibitor treatment (P = .001; OR 42.5; CI 95% 2.2-806.9). Lastly, high BUN levels were associated to age (P = .03; OR 3.8; CI 95% 1.0-14.4), while GFR 60 to 89 mL/min/1.73 m2 was associated to dyslipidemia (P = .02; OR 2.2; CI 95% 1.1-4.5).CD4+ T cell and viral load were the main factors associated with renal biochemical alterations.

Immune status affects the clinical features and outcomes of adult patients with respiratory adenovirus infection

The differences in the clinical features and outcomes of respiratory adenovirus infection (RAI) between immunocompetent and immunocompromised adult patients remain unclear. Thirty-nine adult RAI patients, including 28 (71.8%) immunocompetent patients and 11 (28.2%) immunocompromised patients were enrolled in this retrospective study. Demographic characteristics, symptoms, laboratory tests, radiographic findings, therapies and clinical outcomes were compared between the two groups. We found fever (94.9%), cough (66.7%) and sputum production (56.4%) were the most frequent symptoms. Compared with immunocompetent RAI patients, the immunocompromised RAI patients were more likely to experience anaemia (g/l; 90.8 ± 24.0 vs 134.3 ± 14.6, P < 0.001), thrombocytopaenia ( × 10⁹/l; 116.9 ± 92.7 vs 178.4 ± 74.6, P = 0.037), hypoalbuminaemia (g/l; 29.6 ± 5.5 vs 36.9 ± 5.2, P < 0.001), hyponatraemia (mmol/l; 134.8 ± 5.6 vs 138.5 ± 3.9, P = 0.026) and low levels of cholinesterase (U/l; 2650.5 ± 1467.4 vs 5892.8 ± 1875.1, P < 0.001). Chest computed tomography (CT) scans indicated that lung infiltrate was the most common finding (64.1%). Immunocompromised patients had a higher likelihood of bilateral lung involvement (72.7%) and lower lobe involvement (81.8%) of both lungs. The hospitalized mortality rate was 27.3% in immunocompromised RAI patients, but no death occurred among immunocompetent RAI patients (P = 0.018). Our data suggested immunocompromised RAI patients had worse laboratory test results, more bilateral lung and lower lobe involvement and higher in-hospital mortality compared with immunocompetent RAI patients.

Hyponatraemia as a Predictor of Mortality in Medical Admissions in Ghana: A Comparative Study

Background

Hyponatraemia is the most common electrolyte abnormality in hospital admissions. It occurs in a quarter of medical admissions in Ghana, and it is associated with high mortality. Mortality has been suggested to be due to the underlying medical condition and not necessarily the hyponatraemia. We set out to compare the outcomes of patients with documented hyponatraemia as compared to those with normonatraemia in terms of mortality and length of hospital stay.

Methods

We conducted a comparative analysis of patients with hyponatraemia and those with normonatraemia on the medical ward at the Komfo Anokye Teaching Hospital between May 2018 and December 2018. The medical diagnoses, demographics, and laboratory data of the patients were recorded. Participants' age and gender were matched. Student's t-test was used to test for differences in continuous variables when parametric and Wilcoxon signed-rank test for nonparametric variables. Multiple logistic regression was used to identify predictors of in-hospital mortality. A p value of <0.05 was considered statistically significant.

Results

Within the study period, 846 patients with documented serum sodium were included in the study. The study involved 406 patients with hyponatraemia and 440 patients with normonatraemia. Serum albumin and protein were significantly lower in the hyponatraemia patients as compared to those with normonatraemia. The mortality rate in patients with hyponatraemia was significantly higher than those with normonatraemia (129 (31.8%) vs. 9 (22.3%); OR 1.62 (95% CI: 1.19–2.22), p = 0.002). In-hospital stay was longer in patients with hyponatraemia than normonatraemia (7 (4–10) vs. 6 (3–10) days) but not statistically significant (p = 0.09). Multiple logistic regression showed that low serum sodium (p < 0.001) and low serum albumin (p = 0.009) were the predictors of in-hospital mortality.

Conclusion

Hyponatraemia is associated with significantly higher mortality than normonatraemia and predicts worse prognosis in patients on medical admission. Low serum albumin is also a predictor of mortality in medical admission.

Hyponatremia in Infectious Diseases-A Literature Review

Hyponatremia is one of the most common water-electrolyte imbalances in the human organism. A serum sodium concentration threshold of less than 135 mmol/L is diagnostic for hyponatremia. The disorder is usually secondary to various diseases, including infections. Our review aims to summarize the diagnostic value and impact of hyponatremia on the prognosis, length of the hospitalization, and mortality among patients with active infection. The scientific literature regarding hyponatremia was reviewed using PubMed, ClinicalKey, and Web of Science databases. Studies published between 2011 and 2020 were screened and eligible studies were selected according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and specific inclusion criteria. The most common infections that were associated with hyponatremia were viral and bacterial infections, including COVID-19 (coronavirus disease 2019). The etiology varied according to the infection site, setting and patient cohort it concerned. In several studies, hyponatremia was associated with prolonged hospitalization, worse outcomes, and higher mortality rates. Hyponatremia can also play a diagnostic role in differentiating pathogens that cause a certain infection type, as it was observed in community-acquired pneumonia. Although many mechanisms leading to hyponatremia have already been described, it is impossible with any certainty to ascribe the etiology of hyponatremia to any of them.

An Evaluation to Determine the Strongest CD4 Count Covariates during HIV Disease Progression in Women in South Africa

INTRODUCTION

Past endeavours to deal with the obstacle of expensive Cluster of Difference 4 (CD4+) count diagnostics in resource-limited settings have left a long trail of suggested continuous CD4+ count clinical covariates that turned out to be a potentially important integral part of the human immunodeficiency virus (HIV) treatment process during disease progression. However, an evaluation to determine the strongest candidates among these CD4+ count covariates has not been well documented.

METHODS

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) initially enrolled HIV-negative (phase 1) patients into different study cohorts. The patients who seroconverted (237) during follow-up care were enrolled again into a post-HIV infection cohort where they were further followed up with weekly to fortnightly visits up to 3 months (phase 2: acute infection), monthly visits from 3-12 months (phase 3: early infection) and quarterly visits thereafter (phase 4: established infection) until antiretroviral therapy (ART) initiation (phase 5). The CD4+ count and 46 covariates were repeatedly measured at each phase of the HIV disease progression. A multilevel partial least squares approach was applied as a variable reduction technique to determine the strongest CD4+ count covariates.

RESULTS

Only 18 of the 46 investigated clinical attributes were the strongest CD4+ count covariates and the top 8 were positively and independently associated with the CD4+ count. Besides the confirmatory lymphocytes, these were basophils, albumin, haematocrit, alkaline phosphatase (ALP), mean corpuscular volume (MCV), platelets, potassium and monocytes. Overall, electrolytes, proteins and red blood cells were the dominant categories for the strongest covariates.

CONCLUSION

Only a few of the many previously suggested continuous CD4+ count clinical covariates showed the potential to become an important integral part of the treatment process. Prolonging the pre-treatment period of the HIV disease progression by effectively incorporating and managing the covariates for long-term influence on the CD4+ cell response has the potential to delay challenges associated with ART side effects.

Clinical spectrum of renal disease in hospitalized HIV/AIDS patients: A teaching hospital experience

Background:

Renal involvement in HIV patients is relatively common and quite broad. However, despite an increasingly large number of HIV patients in Asia, systematic studies of renal involvement are lacking.

Objectives:

The study was carried out to delineate the clinical spectrum of renal disease in HIV/AIDS patients hospitalised in a tertiary care centre.

Patients and Methods:

A total of 510 consecutive hospitalised HIV/AIDS with age >18years were included in the study. Detailed demographic, clinical and laboratory data including urinalysis was obtained from all participants.

Results:

Electrolyte disorders were seen in 71% of patients, with the most frequent being hyponatremia (61%). Acute renal failure was seen in 15.8% and CKD was found in 13% of HIV patients. Dipstick proteinuria of grade ≥1+ was seen in 147 patients (29% of total). CD4 count had a significant positive correlation with creatinine clearance, hyponatremia and total leukocyte count, and significant negative correlation with duration of disease and proteinuria.

Conclusion:

Electrolyte disorders and renal involvement are quite common in HIV/AIDS patients from India. Prompt diagnosis and management is required as their presence carry higher morbidity and mortality.

HIV/AIDS-related hyponatremia: an old but still serious problem

Hyponatremia is the most common electrolyte disorder in hospitals. Many medical illnesses, including congestive heart failure, liver failure, renal failure and pneumonia, may be associated with hyponatremia. In addition, hyponatremia in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) was first reported in 1993. The evidence suggests that severe hyponatremia is associated with increased morbidity and mortality in human immunodeficiency virus (HIV)/AIDS patients; however, the incidence of hyponatremic syndrome in HIV/AIDS patients remains very high in clinical practice, as almost 40% of HIV/AIDS inpatients in Xinjiang, a developing region of China, are hyponatremic. A method for identifying the pathogenesis and therapeutic treatments for hyponatremia in HIV/AIDS patients is needed. This review focuses on the clinical and pathophysiological aspects of hyponatremia and highlights the causes, presentation and treatment recommendations for hyponatremic patients with HIV/AIDS.

Butyrylcholinesterase Levels on Admission Predict Severity and 12-Month Mortality in Hospitalized AIDS Patients

Background

Butyrylcholinesterase (BChE) is synthesized mainly in the liver and an important marker in many infectious/inflammatory diseases, but its role in acquired immunodeficiency syndrome (AIDS) patients is not clear. We wished to ascertain if BChE level is associated with the progression/prognosis of AIDS patients.

Methods

BChE levels (in U/L) were measured in 505 patients; <4500 was defined as “low” and ≥4500 as “normal.” Associations between BChE level and CD4 count, WHO stage, body mass index (BMI), C-reactive protein (CRP) level, and duration of hospitalization were assessed. Kaplan–Meier curves and Cox proportional hazards model were used to assess associations between low BChE levels and mortality, after adjustment for age, CD4 count, WHO stage, and laboratory parameters.

Results

A total of 129 patients (25.5%) had a lower BChE level. BChE was closely associated with CD4 count, WHO stage, CRP level, and BMI (all P < 0.001). Eighty-four patients (16.6%) died in the first year of follow-up. One-year survival was 64.5 ± 4.5% for patients with low BChE and 87.6 ± 1.8% for those with normal BChE (log-rank, P < 0.001). After adjustment for sex, age, BMI, WHO stage, and CD4 count, as well as serum levels of hemoglobin, sodium, and albumin, the hazard ratio was 1.8 (95% confidence interval, 1.0–3.2) for patients with a low BChE compared with those with a normal BChE (P = 0.035).

Conclusion

BChE level is associated with HIV/AIDS severity and is an independent risk factor for increased mortality in AIDS patients.

Hyponatremia is a marker of disease severity in HIV-infected patients: a retrospective cohort study

Background

Hyponatremia is a frequent electrolyte disorder in HIV-infected patients with a prevalence of up to 56% in the pre-cART era. Several studies have demonstrated that patients with hyponatremia are at an increased risk of death. We aimed to investigate the prevalence of hyponatremia in the recent cART-era and evaluate its association with mortality.

Methods

Single-center retrospective cohort study. A total of 1196 newly diagnosed and cART-naïve HIV patients followed at the AIDS Reference Center, St Pierre University Hospital in Brussels, Belgium, between 1 January 1998 and 31 December 2013 were included. Hyponatremia was defined as a baseline natremia lower than 135 mmol/l. The outcome of interest was the occurrence of death.

Results

In this study 177 (14.8%) patients had hyponatremia at baseline with a median natremia of 132.0 mmol/l [interquartile range (IQR) 130.0-134.0 mmol/l]. Hyponatremic patients had a lower CD4 cell count (207.5 ± 197.7/μl vs 400.4 ± 277.0/μl; P < 0.0001) and a higher prevalence of AIDS (50.3% vs 12.4%; P < 0.0001) compared to normonatremic patients. A significantly higher proportion of patients with hyponatremia were hospitalized at first contact (72.3% vs 20.0%; P < 0.0001). During the follow-up hyponatremic patients had a shorter median time to a first hospitalization (2.0 IQR [0.0-12.0] months vs 13.0 IQR [2.0-29.0] months; P = 0.001) and an increased incident hospitalization rate (785/1000 patient-years, 95% CI 725–845 vs 370/1000 patient-years, 95% CI 352–388; P < 0.0001]. The incident mortality rate was 28.3/1000 patient-years (95% CI 18.15-42.16) in patients with hyponatremia compared to 9.33/1000 patient-years (95% CI 6.63-12.75) in normonatremic patients (P < 0.0001). Three-year cumulative survival rates were 85.8% ± 3.0% in hyponatremic patients and 96.3% ± 0.7% in normonatremic patients (log-rank P < 0.0001). However, in a multivariate Cox model adjusting for other risk factors such as AIDS, CD4 count < 350/μl and hepatitis C, hyponatremia was no longer a predictor for patient death (hazard ratio: 1.03, 95% CI 0.54-1.97; P = 0.935).

Conclusions

Hyponatremia is a marker of severity of HIV-disease but not an independent risk factor for mortality. HIV-patients with a low serum sodium at baseline might benefit from a close follow-up to improve outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-017-2191-5) contains supplementary material, which is available to authorized users.

Water, electrolytes, and acid-base alterations in human immunodeficiency virus infected patients

The clinical spectrum of human immunodeficiency virus (HIV) infection associated disease has changed significantly over the past decade, mainly due to the wide availability and improvement of combination antiretroviral therapy regiments. Serious complications associated with profound immunodeficiency are nowadays fortunately rare in patients with adequate access to care and treatment. However, HIV infected patients, and particularly those with acquired immune deficiency syndrome, are predisposed to a host of different water, electrolyte, and acid-base disorders (sometimes with opposite characteristics), since they have a modified renal physiology (reduced free water clearance, and relatively increased fractional excretion of calcium and magnesium) and they are also exposed to infectious, inflammatory, endocrinological, oncological variables which promote clinical conditions (such as fever, tachypnea, vomiting, diarrhea, polyuria, and delirium), and may require a variety of medical interventions (antiviral medication, antibiotics, antineoplastic agents), whose combination predispose them to undermine their homeostatic capability. As many of these disturbances may remain clinically silent until reaching an advanced condition, high awareness is advisable, particularly in patients with late diagnosis, concomitant inflammatory conditions and opportunistic diseases. These disorders contribute to both morbidity and mortality in HIV infected patients.