Original Research

Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?

Suman Mewa Kinoo, Savania Nagiah, Anil Chuturgoon, Bhugwan Singh
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1208 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1208 | © 2021 Suman Mewa Kinoo, Savania Nagiah, Anil Chuturgoon, Bhugwan Singh | This work is licensed under CC Attribution 4.0
Submitted: 21 December 2020 | Published: 25 March 2021

About the author(s)

Suman Mewa Kinoo, Department of General Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Savania Nagiah, Department of Human Biology, Faculty of Health Sciences, Nelson Mandela University Missionvale, Port Elizabeth, South Africa
Anil Chuturgoon, Department of Medical Biochemistry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Bhugwan Singh, Department of General Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


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Abstract

Background: The incidence of metabolic disorders in human immunodeficiency virus (HIV) endemic settings is a prevailing burden in developing countries. Cholesterol homeostasis and fat metabolism are altered by HIV and antiretroviral therapy (ART), thereby possibly contributing to complications such as gallstone formation.

Objectives: The aim of this study was to evaluate established risk factors for the formation of cholesterol gallstones in black South African women living with HIV (WLHIV).

Method: A case series study was conducted of all black South African women undergoing cholecystectomy for gallstone disease over a 1-year period at King Edward VIII Hospital, Durban, South Africa. Age, body mass index (BMI), family history of gallstones, oestrogen exposure and lipograms were compared between WLHIV and uninfected women. Categorical variables were tested using either the Fisher’s exact test or Pearson’s chi-square test. Means were compared using independent t-tests. For non-normally distributed data, the Mann–Whitney U test was used. Statistical tests were two-sided, and p-values of less than 0.05 were considered statistically significant.

Results: A total of 52 patients were assessed, 34 HIV-uninfected and 18 WLHIV. The median age of WLHIV versus the uninfected women was 35 and 50 years, respectively, (p = 0.015). A statistically significant number of uninfected women were in the overweight/obese category (BMI > 25 kg/m2) compared to the normal weight category (BMI < 25 kg/m2) (p < 0.001). The number of obese WLHIV did not reach statistical significance.

Conclusion: The age of occurrence of gallstone disease amongst black South African WLHIV was significantly lower and fewer women were obese compared with the uninfected women with gallstone disease. These findings differ from known gallstone risk factors in other populations and in uninfected black South African women. This could be attributed to the metabolic alterations caused by HIV infection itself and/or to the long-term use of ART. Larger cohort studies are required to elucidate the role of HIV and ART in cholestatic disease.


Keywords

HIV; ART; gallstone disease; cholesterol gallstones; HIV-induced cholesterol gallstones; ARV-induced cholesterol gallstones

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