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Page 2 of 8 Original Research

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dysfunction in PLWH was rare. Harslof et al. found no the result transferred onto the data sheets. Screening
difference between treated PLWH and HIV-uninfected thyroxine (T4) levels were not performed at this clinic
persons with regard to the prevalence of hypo- or because of cost implications. The TSH test, measured in
hyperthyroidism. Madge et al. has stated that neither HIV mIU/L, was performed by the National Health Laboratory
11
nor ART increases the risk of overt or subclinical Services (NHLS) using the Siemens® Avdia Centaur XP
hypothyroidism (SCH) in PLWH. 12 analyser. The NHLS’s normal TSH range was 0.35 mIU/L
to 5.5 mIU/L. A history of pre-existing thyroid disorders
People living with HIV who are on ART are now living longer was noted in the medical history and documented as either
and have become susceptible to chronic conditions such as pre-existing hyper- or hypothyroidism. For this study,
DM. In some instances, HIV-infected patients have developed patients without a history of a thyroid disorder but with a
insulin resistance resulting from the inflammatory changes TSH level < 0.35 mIU/L were classified as having
that accompany long-term HIV infection and the metabolic subclinical hyperthyroidism, whilst those patients with a
toxicities of the early antiretrovirals used at the time. 13,14 TSH > 5.5 mIU/L and no history of a thyroid disorder were
captured as having SCH. Patients with elevated TSH were
The prevalence of thyroid abnormalities in a United Kingdom further subdivided into two groups (5.5–10 mIU/L vs. > 10
15
population (the Whickham Survey) was reported to be mIU/L). This was done as both categories have specific
approximately 6.6%. These data are not specific to PLWD and therapeutic implications. Total thyroid disorders were
precede the HIV pandemic by several years. The Colorado categorised as all patients with either a history of hyper- or
(USA) thyroid disease prevalence study of 1995 (n = 25 862) hypothyroidism plus all those who were found to have
found that 9.5% of attendees at a state fair had an elevated subclinical hypo- or hyperthyroidism. The Bio-Rad D-10
TSH test result whilst 2.2% had decreased levels. The overall machine (Bio-Rad, USA) was used for the HbA1c analysis.
16
prevalence of thyroid abnormalities in PLWD is between 12%
and 16%. 1,17,18,19 Although a Nigerian and an Indian study The device and the operator (the NHLS) are National
found higher prevalence rates, namely 46.5% and 30%, Glycohaemoglobin Standardisation Program (NGSP)
respectively, these PLWD subjects may have been non- accredited. Estimated glomerular filtration rates (eGFR)
randomly recruited. Subclinical hypothyroidism was the were calculated by the NHLS using the Modified Diet in
most frequent diagnosis. 20,21 Renal Disease (MDRD) formula. The CD4 results are
reported in cells/µL or cells/mm .
3
Screening guidelines for thyroid disorders in PLWD remain
varied globally. 1,21,22,23,24 Thyroid-stimulating hormone is the This is a retrospective cross-sectional study of demographic,
most sensitive screening test and establishes the diagnosis of clinical and biochemical data, including TSH results,
hypo- and hyperthyroidism. 19,25,26 In the context of HIV, Parsa extracted and analysed from the datasheets of all first-visit
et al. recommend that TSH be the initial screening tool for the patients attending the diabetic clinic from 1 January 2016 till
diagnosis of thyroid disorders in PLWH. Global and South 31 December 2017.
27
African data on the prevalence of thyroid abnormalities in
PLWHD are scarce. International guidelines vary with regard Categorical and continuous variables were noted as median
to TSH screening in PLWH and/or PLWHD. and interquartile ranges (25% – 75% IQR). Numbers (n) and
percentages (%) are provided for categorical variables.
The primary aim of this study was to provide an initial Since data was non-parametric, all data were log-
description of some of the thyroid/TSH abnormalities found transformed. The results shown are back-transformed
in South African PLWHD and in those South African PLWD values. A p-value < 0.05 was used as an indicator of
who are HIV uninfected. A secondary aim was to identify the significance. Data were analysed by Statistical Package for
extent, if any, of differences in thyroid/TSH abnormalities Social Science (SPSS) version 25 for windows (SPSS Inc.,
between PLWHD and HIV-uninfected PLWD. Chicago, IL, USA) and Medcalc (version 19.3.1, Ostend,
Belgium).
Methods

The visits of all patients attending the Edendale Hospital Patient and public involvement
diabetic clinic are recorded on specially designed data sheets. Informed consent was not sought as the study is retrospective
These were introduced in September 2012 and are completed and all patient-identifying information was anonymised in
in triplicate and have been approved by the University of the study database. Neither patients nor the general public
KwaZulu-Natal Biomedical Research and Ethics Committee were involved in the design, the operation, the reporting or
(BCA 194/95). This ensures that all patients are consulted in the dissemination of this research.
a standardised and comprehensive manner. Demographic,
clinical and biochemical variables for the patients are Ethical consideration
captured on these data sheets.
Ethics approval for this study was received from the
In order to identify concomitant thyroid disorders, TSH University of KwaZulu-Natal Biomedical Research and
tests are performed routinely at all initial clinic visits and Ethics Committee (BE 137/19).

http://www.sajhivmed.org.za 315 Open Access