A Study of Electrolyte Disturbances in HIV Infected Patients

INTRODUCTION: AIDS was first recognized in the United States in the summer of 1981, when the U.S. Centers for Disease Control and Prevention (CDC) reported the unexplained occurrence of Pneumocystis jiroveci (formerly P. carinii) pneumonia in five previously healthy homosexual men in Los Angeles and of Kaposi's sarcoma (KS) with or without P. jiroveci pneumonia in 26 previously healthy homosexual men in New York and Los Angeles. Within months, the disease became recognized in male and female injection drug users (IDUs) and soon thereafter in recipients of blood transfusions and in hemophiliacs. As the epidemiologic pattern of the disease unfolded, it became clear that an infectious agent transmissible by sexual (homosexual and heterosexual) contact and blood or blood products was the most likely etiologic cause of the epidemic. In 1983, human immunodeficiency virus (HIV) was isolated from a patient with lymphadenopathy, and by 1984 it was demonstrated clearly to be the causative agent of AIDS. In 1985, a sensitive enzymelinked immunosorbent assay (ELISA) was developed, which led to an appreciation of the scope and evolution of the HIV epidemic at first in the United States and other developed nations and ultimately among developing nations throughout the world. Luc Montaineger from Pasteur Institute, France, discovered the causative agent in 1983,and labelled it as LAV -2 lymphadenopathy associated virus.[2]. Robert Gallo from USA also isolated the virus in 1984, and named it HTLV-III, Human T Lymphotropic Virus-III. The International committee on Taxonomy of Viruses re designated both the viruses and named it as Human Immunodeficiency Virus. Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV) which can be contracted through sexual contact, exposure to blood including sharing contaminated needles and syringes and by certain blood products or other body fluids. Human immunodeficiency virus/acquired immunodeficiency syndrome has been the leading cause of death among young adults in the United state and has a devastating impact on people in the developing countries. The clinical presentation of this disease include pneumonia, fever/pyrexia loss of vision, night sweats, chronic diarrhoea, weight loss, lymphadenopathy, cough, and itchy maculopapular generalized skin rash, blue discolouration, anaemia and hairy leukoplakia. AIMS OF THE STUDY: 1 To find out the prevalence of electrolyte disturbances in HIV infected Patients. 2. And their correlation with CD4+ counts. MATERIAL AND METHODS: Study design : Cross sectional study. Study Population: The cross sectional study included all 150 patients admitted in medicine and STD wards, GRH. Both male and female patients were included in this study. Place : Medicine Dept., Govt. Rajaji Hospital, Madurai Medical College, Madurai. Collaborative Departments: 1) Department of Bio-Chemistry, Govt. Rajaji Hospital, Madurai Medical College, Madurai and 2) Department of STD, Govt. Rajaji Hospital, Madurai Medical College, Madurai. Period of study: 6 months (Nov 1, 2008 to April 30, 2009). Sample size: 150 patients. Selection of the study subjects: 150 patients admitted with HIV infection in the medical and STD wards, Govt. Rajaji Hospital from July to December 2008 formed the study group. All patient’s with HIV infection, admitted in both medical and dept. of STD are included in this study which includes both AIDS related complex and AIDS. Since only symptomatic patients and patients with opportunistic infections(eg. T.B meningitis, chronic diarrhea, etc., ) are getting admitted in wards, asymptomatic patients were not included in this study. 111 male and 39 female patients were included in this study. Sex distribution is shown in table 1. RESULTS: It indicate the mean age is 30.85 ± 4.78 (±1SD). The minimum and maximum CD4+ counts are 75, 349/micro litre respectively. The mean CD4 count is 209.45±80.88/micro litre (±1SD).The mean serum sodium level is 136.65±6.00(±1SD)Meq/litre. The minimum and maximum serum sodium level are 125 Meq/litre,146 Meq/litre respectively (Figure 6) (Table 1).The mean serum potassium levels is4.01±0.95 Meq/litre (±1SD). The minimum and maximum serum potassium levels observed are 2.5 Meq/litre, 7.4 Meq/litre respectively (table 2) (Figure 7). Among 150 pt’s, 52 pt’s had hyponatremia and 98 patients had normal sodium levels (Figure2). The percentage of hyponatremia is 34.7%. Among the 52 patients, female patients are 32 and males are 20 . And the percentage of hyponatremia for both males and females are 14.7%, 20.0% respectively (table 3) (Figure 4). CONCLUSION: Hyponatremia, hypokalemia and hyperkalemia are common electrolyte disorders with HIV infected patients. Because of the high incidence of the electrolyte disturbances with HIV infected patients, close monitoring and aggressive management are mandatory