Page 322 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

Human immunodeficiency virus, diabetes mellitus and

thyroid abnormalities: Should we be screening?

Authors: Background: Diabetes mellitus (DM) and human immunodeficiency virus (HIV) are associated
Somasundram Pillay with thyroid abnormalities. Scarce literature exists on the prevalence of thyroid abnormalities
1,2
Davashni Pillay 3
Deepak Singh 4 in people living with HIV (PLWH) and DM (PLWHD). Guidelines vary regarding thyroid-
Romashan Pillay 5 stimulating hormone (TSH) screening in PLWH and/or DM.
Affiliations: Objectives: This study describes thyroid abnormalities in PLWHD and HIV-uninfected people
1 Department of Internal living with DM (PLWD).
Medicine, King Edward VIII
Hospital, Durban, South Africa Method: This was a cross-sectional analysis of demographic, clinical and biochemical data
including TSH results of first-visit patients to the Edendale Hospital diabetes clinic between
2 Department of Internal
Medicine, University of January 2016 and December 2017.
KwaZulu-Natal, Durban, Results: A total of 915 patients were enrolled: 165 PLWHD and 750 PLWD. Overall prevalence
South Africa
of thyroid disorders in PLWD was 8.53% (64/750). The occurrence of ‘total’ thyroid disorders
3 Star College Girls Durban, and of ‘subclinical-hypothyroidism’ (SCH) was higher in PLWHD than PLWD (23.03% vs.
Durban, South Africa 8.53% and 20.61% vs. 4%, p < 0.001; respectively). People living with HIV and diabetes with
thyroid disorders had lower CD4 counts than PLWHD without thyroid disorders (376.08 ±
4 Department of Physics, 333.30 vs. 509 ± 341.7 cells/mm ; p = 0.004). Subclinical-hypothyroidism was more common
3
Durban University of
Technology, Durban, in patients on antiretroviral therapy [ART] (27/136 [19.85%] vs. 4/27 [14.81%], p < 0.001).
South Africa A significant number of PLWHD acquired HIV before the onset of DM (107/165 [64.85%] vs.
58/165 [35.15%], p < 0.001). Patients on ART were more likely to develop DM, OR 2.66
5 Clifton College Durban, (95% CI 1.11–6.38).
Durban, South Africa
Conclusion: Our study showed an increased prevalence of thyroid disorders (especially
Project Research Registration:
Project Number: BE 137/19 SCH) in PLWD and a higher prevalence in PLWHD. Young, overweight, female PLWHD
were at risk of SCH. People living with HIV and DM on ART demonstrated an increased
Corresponding author: prevalence of thyroid dysfunction and poor lipaemic control. The introduction of combined
Somasundram Pillay, communicable–non-communicable disease clinics might provide an integrated patient
[email protected]
screening option.
Dates:
Received: 18 June 2020 Keywords: patients with diabetes mellitus; HIV infection; thyroid disorders; antiretroviral
Accepted: 04 Sept. 2020 therapy; patient screening options.
Published: 09 Nov. 2020

How to cite this article: Introduction
Pillay S, Pillay D, Singh D,
Pillay R. Human The emerging burden of diabetes mellitus (DM) and chronic human immunodeficiency virus
immunodeficiency virus,
diabetes mellitus and thyroid (HIV) infection will inflict strain on the limited resources of the low- and middle-income
abnormalities: Should we be countries of Africa. Both conditions have been independently associated with thyroid
screening? S Afr J HIV Med. dysfunction. 1,2,3,4 Furthermore, thyroid disorders may destabilise the control of both HIV and
2020;21(1), a1116. https://
1,5
doi.org/10.4102/sajhivmed. DM. Thyroid hormones participate in carbohydrate metabolism, insulin secretion and
6
v21i1.1116 pancreatic function. Similarly, hypothyroidism is associated with the decreased secretion of
insulin from the pancreas. 7
Copyright:
© 2020. The Authors.
Licensee: AOSIS. This work Shujing et al. showed that thyroid dysfunction, particularly hypothyroidism, is common (33.1%)
is licensed under the in people living with HIV (PLWH). This study found that CD4 levels were lower in those with
Creative Commons hypothyroidism and that overall biochemical thyroid dysfunction was more frequent in those on
Attribution License.
antiretroviral therapy (ART) versus those patients who were ART-naïve (39.4% vs. 24.3%,
2
p < 0.05, respectively). Other researchers have also noted an increase of thyroid dysfunction in
Read online: PLWH. In these studies, few, namely 1% – 2% of PLWH, exhibit overt thyroid disease. However,
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Scan this QR up to 35% have thyroid-related biochemical abnormalities. 3,4,8,9 The data have not always been
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smart phone or consistent. Jain et al. observed an inverse correlation between CD4 and thyroid-stimulating
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hypothyroid state. In contrast, Lambert noted that both overt and biochemical thyroid
5
http://www.sajhivmed.org.za 314 Open Access