Page 289 - HIVMED_v21_i1.indb

Page 7 of 8 Original Research

Consequently, the presence of comorbid HIV and DM in the respective doses were not included. This could have been
black African population potentially increases the risk of used to compare the DM treatment requirements in PLWH/
vitamin D deficiency and hypocalcaemia, which might DM and HIV-uninfected patients as both groups had similar
negatively impact HIV and DM control. The role of vitamin HbA1c levels. Lastly, because of the retrospective nature of
D in the pathogenesis and control of HIV and DM and the the study, causality could not be determined. However, this
effect of vitamin D supplementation need to be further is a newly explored topic, and this study is useful in providing
explored, particularly in the black African population. preliminary data for future prospective studies.

Phosphate Conclusion
The risk of TDF-induced nephrotoxicity with isolated Serum electrolyte abnormalities in black African PLWH/DM
hypophosphataemia, proximal tubular dysfunction or Fanconi are common. Hypocalcaemia and hyponatraemia were the
syndrome increases in the presence of renal impairment. most frequent electrolyte abnormalities and occurred more
38
This is of particular concern in patients with comorbid HIV frequently in PLWH/DM compared with HIV-uninfected
and DM, advancing age, lower CD4 cell counts and elevated patients with DM. Serum calcium levels were significantly
baseline creatinine levels. Our study did not find TDF to be lower in black African PLWH/DM compared with HIV-
38
significantly associated with hypophosphataemia or serum uninfected patients with DM. Importantly, hyponatraemia
phosphate levels in PLWH/DM. This could be attributed to is a potential marker of impaired glycaemic control as
the fact that our study had only 12.5% of PLWH/DM with an elevated HbA1c levels significantly increased the odds of
eGFR <60 mL/min/1.73m , patients were using ART for a hyponatraemia in both groups; however, the odds were
2
median duration of only 6 years and PLWH/DM were greater in PLWH/DM. Ultimately, black African PLWH/DM
relatively young. A study by Day et al. observed the frequency are highly vulnerable to electrolyte abnormalities because
of hypophosphataemia in TDF recipients to be higher than of multifactorial pathophysiological factors. Further large
non-TDF ART recipients (31% vs. 22%). However, no prospective studies regarding electrolyte abnormalities
independent association was found between TDF use and the in black African PLWH/DM will assist in identifying
frequency or severity of hypophosphataemia. The recognition contributory factors and implementing tailored guidelines
39
that hypophosphataemia in PLWH on TDF is multifactorial that could facilitate prevention, earlier detection, closer
must be considered to avoid unnecessary TDF cessation in a monitoring and appropriate intervention to reduce associated
resource-limited setting. adverse effects in this high-risk population, particularly in
the South African context.
Current guidelines Acknowledgements
This study determined that electrolyte abnormalities in black
African PLWH/DM are common, with hypocalcaemia This study contributes towards the Master of Medical
and hyponatraemia being the most frequent electrolyte Science degree of Dr Preyanka Pillay, which is supervised
abnormalities. However, the current SEMDSA guidelines by Dr Somasundram Pillay.
only recommend that serum potassium needs to be measured
at diagnosis and monitored annually. Furthermore, South Competing interests
37
African HIV guidelines only recommend the monitoring of The authors declare that they have no competing interests.
serum potassium and phosphate in high-risk patients and
patients with features of tubular wasting. 36
Authors’ contributions
Limitations P.P. contributed to the conception and design of the study as
well as the collection, analysis and interpretation of the data.
The limitations of this study included CD4 count and viral P.P. wrote and edited the manuscript. S.P. contributed to the
load not being documented for a majority of patients as conception and design of the study and critically reviewed
management and monitoring of HIV occurs at designated and edited the manuscript. N.M. contributed to the statistical
HIV clinics. Therefore, the association between HIV control analysis and interpretation of data; she also critically
and electrolyte abnormalities could not be determined. reviewed and edited the manuscript. All authors gave final
Possible TDF-induced proximal tubular dysfunction and
electrolyte loss were not assessed with urine electrolytes as approval of the version to be published.
they were not routinely performed in the DM clinic. Patients
in this study could have been on medication or could have Funding information
comorbidities which may affect electrolytes. However, by This research received no specific grant from any funding
including these patients the study was more representable agency in the public, commercial or not-for-profit sectors.
and reproducible as the majority of patients suffering from
DM were usually part of a metabolic syndrome which
requires chronic treatment to improve outcomes. In addition, Data availability statement
the use of oral antidiabetic medication or insulin and the Data are available upon request from the corresponding author.

http://www.sajhivmed.org.za 281 Open Access