Hyponatremia in patients with acquired immune deficiency syndrome

Article Abstract:

Hyponatremia is a disturbance in the body's metabolism resulting in a low concentration of sodium in the blood. Hyponatremia may be caused by abnormal secretion of the antidiuretic hormone (ADH) by the adrenal gland, in possible combination with an increased intake of water and decreased removal of water by the kidneys. Hyponatremia causes confusion and tiredness, and can lead to convulsions and coma. The prognosis of patients with AIDS and hyponatremia is poor. The incidence, clinical significance, and prognosis of hyponatremia were studied in 96 patients with AIDS-related complex or AIDS. Hyponatremia was seen in 31 percent (30 out of 96) of the patients with AIDS-related complex or AIDS. Twenty out of 57 patients (35 percent) developed hyponatremia outside of the hospital when the they were being treated on an outpatient basis, and 10 out of 39 (27 percent) developed hyponatremia when they were in the hospital. Patients with hyponatremia had a greater frequency of opportunistic infections, including Pneumocystis carinii pneumonia and cytomegalovirus infections. The death rate of AIDS patients with hyponatremia was 70 percent, which was twice that of patients without hyponatremia. The length of time that 50 percent of patients survived after diagnosis of HIV infection was 11.5 months for those with hyponatremia compared with 39 months for those without hyponatremia. The length of time after the development of hyponatremia that 50 percent of patients survived was 4.5 months. Two patients developed Addison's disease (a serious disease caused by partial or complete failure of the adrenal gland), and 15 had high levels of sodium in their urine but did not have any evidence of problems with their kidneys or adrenal glands. The cause of the high levels of urinary sodium was not determined. This study showed that hyponatremia commonly occurs in patients with AIDS-related complex and AIDS, and is associated with an increased incidence of complications and death. Hyponatremia is not a symptom characteristic of the terminal stages of AIDS, since it also occurred in patients with AIDS-related complex. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hyponatremia, Water-electrolyte imbalances, Fluid-electrolyte imbalance, Sodium metabolism disorders

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The importance of confounding factors in the evaluation of neuropsychological changes in patients infected with human immunodeficiency virus

Article Abstract:

Patients with AIDS often develop cognitive deficits (impairment of the ability to think). It is not clear at what stage the human immunodeficiency virus (HIV) enters into the nervous system and causes changes in mental processes. The possibility of changes occurring early in HIV infection has lead to discrimination in employment, with employers fearing that job performance will be affected. Other factors besides HIV infection that may cause cognitive impairment were examined in 40 patients infected with HIV. The degree of impairment was found to be correlated with the existence of certain confounding factors (factors other than stage of HIV infection). Stage of infection was assessed by the existence of symptoms of AIDS or AIDS-related complex and the numbers of various subsets of T lymphocytes, a commonly used criteria to assess the degree of immune impairment and stage of HIV infection. No correlation existed between cognitive impairment and the age of the subjects, nor whether they were using azidothymidine (AZT). Confounding factors that were found to be associated with cognitive skills included: pre-existing neurologic disease, such as epilepsy and head injury; developmental or learning disabilities; substance abuse; and pre-existing psychiatric problems requiring hospitalization, such as schizophrenia, bipolar disorder, and psychotic depression. Therefore, the early stages of HIV infection are not associated with a high rate of cognitive impairment if underlying confounding neuropsychological characteristics of the subjects are considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Cognition disorders, Cognitive disorders, Clinical neuropsychology

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HIV-associated autoimmune hemolytic anemia: report of a case and review of the literature

Article Abstract:

Autoimmune hemolytic anemia (AIHA) is only rarely seen in patients infected with the human immunodeficiency virus (HIV). There have been 12 reports of patients with AIHA and HIV infection. A case study is described of a patient with AIDS-related complex who developed AIHA with reticulocytopenia (reduced numbers of reticulocytes, immature red blood cells). The patient had severe hemolysis (lysis of red blood cells), including anhaptoglobinemia, the lack of a blood protein that binds and is involved in the removal of free hemoglobin (the pigment-carrying protein of red blood cells). He also had microspherocytosis (irregularly shaped red blood cells) and splenomegaly, an enlarged spleen. It is thought that treatment with azidothymidine (AZT) for the HIV infection may have made his anemia worse, but that AZT was not the cause of the anemia. The patient's spleen was surgically removed, resulting in remission of the AIHA after a period of time. The AIHA went into remission even though the patient was still being treated with AZT. Autoimmune antibodies (antibodies made against normal body components) produced against red blood cells are thought to be the cause of AIHA in patients with HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Autoimmune diseases, Hemolytic anemia

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