Evaluation of serum thyroid hormones and lipid levels in HIV-infected patients on highly active antiretroviral therapy at the Jaramogi Oginga Odinga teaching and referral hospital in Kisumu county, western Kenya

Abstract

While Highly Active Antiretroviral Therapy (HAART) has significantly reduced HIV-associated mortalities, they are not devoid of adverse effects including endocrine and metabolic disorders like thyroid dysfunctions and dyslipidemias. However, Alterations in serum thyroid hormones and lipid levels among HAART users in Sub-Saharan population like Kenya is yet to be elucidated. This study determined the serum lipid levels; Total cholesterol (TC), Triglycerides (TG), High Density Lipoproteins (HDL), Low Density Lipoproteins (LDL) and the serum Thyroid hormones levels; Thyroid Stimulating Hormone (TSH), Thyroxine (T4) and Triiodothyronine (T3) levels among the HAART-treated and HAART-naïve subjects. Using cross study design, patients (n=104) attending Jaramogi Oginga Teaching and Referral Hospital (JOOTRH) in Kisumu County, Western Kenya were recruited. The study participants were categorized into two groups; HAART-treated (84) and HAART-nave (20). Demographic, medical history and anthropometric data were collected after which fasting state blood was collected and centrifuged to obtain serum. Colorimetric method was used to determine the serum TC, TG, HDL, and LDL levels while immunofluorescence method was used to determine the serum TSH, T4 and T3 levels. The difference in serum lipid and thyroid hormones levels between HAART-treated and HAART-naïve groups were determined using Mann Whitney U test while Spearman correlation test was used to determine the association between serum lipids and serum thyroid hormones levels. Although the thyroid hormones were found to be within normal ranges in both groups, TSH levels were significantly higher among the HAART-treated patients than in HAART-naïve counterparts, [median (IQR) 1.72 (1.71) nmo/L vs median (IQR), 0.87 (1.07) nmo/L, P=0.001]. However, the serum T4 and T3 levels were similar in both the HAART-treated and HAART-naïve patients, [median (IQR) 144.39 (67.53.64) nmo/L vs median (IQR), 136.99 (134.22) nmo/L, P=0.426] and [median (IQR) 2.43 (2.73) nmo/L vs median (IQR) 3.10 (2.62) nmo/L, (P=0.147) respectively. The serum lipids levels, were all within normal ranges, and did not differ significantly between the HAART-treated patients and the HAART-naïve counterparts; TC, [median (IQR) 186.00 (91.50) mg/dl vs median (IQR) 149.50 (70.30) mg/dl, (P=0.092)]; HDL, [median (IQR) 52.50 (24.00) mg/dl vs median (IQR) 44.00 (34.00) mg/dl, (P=0.280)], LDL, [138.00 (86.30) vs 117.00(46.50), (P=0.476)] as well as TG [median (IQR) 82.00 (62.80) mg/dl vs median (IQR) 94.50 (55.80) mg/dl, (P=0.504)]. While a positive association was found between T4 and LDL levels, (ρ =0.240, P=0.014), no association was established between serum TSH as well as T3 levels and serum lipid profiles. This study shows that there is varying serum TSH levels HAART-treated and HAART-naive patients and that serum LDL levels increases with increase in serum T4 levels. Routine monitoring of serum lipids and thyroid hormones levels for the HIV-infected patients particularly those on HAART treatment is therefore recommended.