Abstract
BackgroundSerum electrolyte abnormalities in black African people living with human immunodeficiency virus (HIV) and diabetes mellitus (PLWH/DM) is unknown.ObjectivesThe aim of this study was to analyse serum electrolytes (sodium, potassium, calcium and phosphate) and factors associated with electrolyte abnormalities in black African PLWH/DM versus HIV-uninfected patients with DM.MethodsWe conducted a retrospective case-control study in 96 black African PLWH/DM (cases) and 192 HIV-uninfected patients with DM (controls), who were visiting the Edendale Hospital DM clinic, from 01 January 2016 to 31 December 2016. Pearson’s correlation, multivariate linear and logistic regression analyses were utilised.ResultsHypocalcaemia was the most frequent electrolyte abnormality in PLWH/DM and HIV-uninfected patients with DM (31.25% vs. 22.91%), followed by hyponatraemia (18.75% vs. 13.54%). Median (IQR) corrected serum calcium levels were significantly lower in PLWH/DM compared with HIV-uninfected patients with DM (2.24 [2.18–2.30] mmol/L vs. 2.29 [2.20–2.36] mmol/L; p = 0.001). For every per cent increase in glycated haemoglobin, the odds of hyponatraemia significantly increased in both PLWH/DM (odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.19 –2.02; p = 0.003) and HIV-uninfected patients with DM (OR: 1.26; 95% CI: 1.04 –1.54; p = 0.009).ConclusionHypocalcaemia and hyponatraemia were the most frequent electrolyte abnormalities and occurred more frequently in PLWH/DM compared with HIV-uninfected patients with DM. People living with HIV and DM have significantly lower corrected serum calcium levels compared with HIV-uninfected patients with DM. Furthermore, hyponatraemia is a marker of impaired glycaemic control.
Highlights
Low- and middle-income countries account for 80% of the global diabetes mellitus (DM) burden.[1]
People living with human immunodeficiency virus (HIV) and DM had a median (IQR) duration of HIV of 7 (3–10) years and 86 (89.58%) patients were on antiretroviral therapy (ART), which included 65 (67.7%) patients on TDF (Table 1)
Elevated HbA1c levels significantly increased the odds of hyponatraemia, with the odds being greater in people living with HIV (PLWH)/DM compared with their HIV-uninfected counterparts
Summary
Low- and middle-income countries account for 80% of the global diabetes mellitus (DM) burden.[1]. Electrolytes play a vital role in maintaining homeostasis and are paramount in mediating enzymatic reactions, cellular function and electrical gradients.[7] Patients with HIV or DM are predisposed to electrolyte abnormalities because of multifactorial pathophysiological factors.[8,9] The risk of nephropathy, with subsequent electrolyte abnormalities, increases in the setting of comorbid HIV and DM. The black African population has distinct electrolyte physiology and a predisposition to chronic kidney disease and HIV-associated nephropathy (HIVAN).[10] In addition, the use of tenofovir (TDF) increases the risk of proximal tubular dysfunction and subsequent hypokalaemia and hypophosphataemia.[11]. Serum electrolyte abnormalities in black African people living with human immunodeficiency virus (HIV) and diabetes mellitus (PLWH/DM) is unknown
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