Changing electrolyte and acido-basic profile in HIV-infected patients in the HAART era.
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.


METHODS
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.
Department of Nephrology, Pitié-Salpêtrière Hospital, AP-HP and CERVI, Paris, France. corinne.bagnis@psl.ap-hop-paris.fr
Corinne
C
Isnard Bagnis
Sophie Tezenas
ST
Du Montcel
Michele
M
Fonfrede
Marie Chantal
MC
Jaudon
Vincent
V
Thibault
Guislaine
G
Carcelain
Marc Antoine
MA
Valantin
Hassan
H
Izzedine
Aude
A
Servais
Christine
C
Katlama
Gilbert
G
Deray
D000136:Acid-Base Equilibrium; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D001639:Bicarbonates / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D004573:Electrolytes / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D033461:Hyperuricemia / Q000139:chemically induced; D017674:Hypophosphatemia / Q000139:chemically induced; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
D001639:Bicarbonates; D001786:Blood Glucose; D004573:Electrolytes; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D003404:Creatinine; D008274:Magnesium; D002118:Calcium