| dc.description.abstract | Serum electrolytes disorders in HIV patients in addition to resulting from disease induced
fluids losses or accumulation could be attributed to a wide range of structural defects of
cellular apparatus, tissue or organs of regulation. Most routine clinical investigation of
impaired serum electrolytes in HIV infection limit attribution to body fluids charges and to
primary organs of regulations. Such investigations do not address the likelihood of
existence of multiple regulatory organs defects, the contribution of secondary regulatory
organs and of non elemental electro chemical forces in establishing observed serum
electrolytes states in HIV infection. This study investigated the association of electrolytes
levels with kidney and liver functions in HIV infection in order to explore the extent of
contribution of the renal and gastrointestinal primary regulatory organs to existing serum
electrolytes disorders in light of the extended range of HIV impact on multiple organs of
electrolytes regulation. This was a hospital based cross sectional study enrolling
consecutive attendants of the PSC at Jaramogi Oginga Odinga Teaching and Referral
Hospital. 800 HIV-infected and 406 seronegative controls were enrolled. Biochemical
analysis was done of serum levels of major electrolytes (Na+, K+ and Cl-), markers of
kidney function (creatinine and urea) and liver pathology (bilirubin, albumin, total protein
and enzymes) and related body fluids parameters (osmolality and pressure). Frequency
counts and measures of central tendency and dispersion around normal reference values
were used to assess the distribution of analytes in the population. Associations of HIV
status, CD4 count, ARV use, age and gender with electrolytes and fluid parameters were
tested using, t-tests and Chi-square and regression logistics (r and r2) and significance
levels assigned using α = 0.05. Female gender, increasing age and CD4<200cells/mm3
emerged as determinants of occurrence of kidney disorders which were observed in 54%
of the seropositive individuals. HIV infection conduced significant reduction in mean
eGFR (88.1mls/min v/s 95.5mls/min, t=3.1, p=0.001). Therefore creatinine and urea
imbalance were more prevalent in seropositive than healthy controls (26.1% vs11.8%;
p<0.0001, 4.4% vs 0.5%, p<0.0001). liver function indicators; albumin, total proteins,
bilirubin and enzymes (AST and ALT), were significantly impaired in seropositive than
seronegative individuals; (32.8g/l vs 34.5g/l, t=5.3,p<0.0001); 64g/l vs 67.1g/l,
t=6.7,p<0.0001); (6.2vs5, t=5.7,p<0.0001) AST;45.1U/l vs 36.9U/l, t=10.3,p<0.0001 and
ALT;36.5U/l vs 30.7U/l, t=7.2,p<0.0001). Serum Na+, K+ and Cl- ion imbalance were
observed in 26.1%, 27.4% and 17.3% of HIV+ individuals respectively with only the
prevalence of sodium imbalance being significantly more in HIV+ than HIV- individuals
(26.1% vs 17.7%, χ
2 =10.6, p = 0.001). Using ARVs was accompanied with significant
reduction in prevalence of Na+ ion imbalance (24.6%vs32.3%, χ
2 =3.98, p=0.046). Rates
of electrolytes imbalance in HIV+ infection did not differ with or without kidney disorders
and only 0.1% Na+, 0.01 % K+ and 0.3 % Cl- imbalance were attributable to kidney
defects. Lower prevalence of K+ imbalance (OR=0.6, χ
2 =10.5,p=0.001; OR=0.6, χ
2
=6.7,p=0.01) were associated with albumin and total protein depletion while higher rates
of Na+ (55.5%vs25.4%, χ
2 =8.3,p=0.004) and K+(38.9% vs 16.8%, χ
2 =6,p=0.01)
imbalance were associated with hyperbilirubinemia. Nonetheless co-variation between
electrolytes imbalance and liver markers were minimal. Thus impaired liver and kidney
functions did not sufficiently explain occurrence of the multiple electrolytes imbalance in
HIV infection. Therefore diagnostic and management practices of electrolytes disorders in
HIV-infected individuals need to expand to include comprehensive biochemical
assessment of probable causes to reach as many as the likely elemental contributors as
possible. | en_US |
