Original Research

Human immunodeficiency virus, diabetes mellitus and thyroid abnormalities: Should we be screening?

Somasundram Pillay, Davashni Pillay, Deepak Singh, Romashan Pillay
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1116 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1116 | © 2020 Somasundram Pillay, Davashni Pillay, Deepak Singh, Romashan Pillay | This work is licensed under CC Attribution 4.0
Submitted: 18 June 2020 | Published: 09 November 2020

About the author(s)

Somasundram Pillay, Department of Internal Medicine, King Edward VIII Hospital, Durban, South Africa; and, Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
Davashni Pillay, Star College Girls Durban, Durban, South Africa
Deepak Singh, Department of Physics, Durban University of Technology, Durban, South Africa
Romashan Pillay, Clifton College Durban, Durban, South Africa


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Abstract

Background: Diabetes mellitus (DM) and human immunodeficiency virus (HIV) are associated with thyroid abnormalities. Scarce literature exists on the prevalence of thyroid abnormalities in people living with HIV (PLWH) and DM (PLWHD). Guidelines vary regarding thyroidstimulating hormone (TSH) screening in PLWH and/or DM.
Objectives: This study describes thyroid abnormalities in PLWHD and HIV-uninfected people living with DM (PLWD).
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 January 2016 and December 2017.
Results: A total of 915 patients were enrolled: 165 PLWHD and 750 PLWD. Overall prevalence of thyroid disorders in PLWD was 8.53% (64/750). The occurrence of ‘total’ thyroid disorders and of ‘subclinical-hypothyroidism’ (SCH) was higher in PLWHD than PLWD (23.03% vs. 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 ± 333.30 vs. 509 ± 341.7 cells/mm3; p = 0.004). Subclinical-hypothyroidism was more common in patients on antiretroviral therapy [ART] (27/136 [19.85%] vs. 4/27 [14.81%], p < 0.001). 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 (95% CI 1.11–6.38).
Conclusion: Our study showed an increased prevalence of thyroid disorders (especially 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 prevalence of thyroid dysfunction and poor lipaemic control. The introduction of combined communicable–non-communicable disease clinics might provide an integrated patient
screening option.

Keywords

patients with diabetes mellitus; HIV infection; thyroid disorders; antiretroviral therapy; patient screening options

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