European Journal of Cardiovascular Medicine

HIV infects cluster of differentiation 4 (CD4) T-lymphocytes, monocytes, and macrophages. As a result of this infection, the number and function of CD4 cells are reduced and both cell-mediated and humoral immunity are affected [1].

Magnesium is an important electrolyte. Magnesium is involved in most metabolic processes and contributes to DNA and protein synthesis. Magnesium is involved in the regulation of mitochondrial function, inflammatory process and immune defense, allergy, growth and stress and in the control of neuronal activity, cardiac excitability, neuromuscular transmission, vasomotor tone and blood pressure.  Normal serum magnesium levels are between 1.46 and 2.68 mg/dL. Hypomagnesaemia is an electrolyte disturbance caused when there is a low level of serum magnesium (less than 1.46 mg/dL) in the blood [2].

The high disease burden of HIV has necessitated a rapid increase in the use of Antiretroviral therapy (ART). ART has reduced both the morbidity and mortality of HIV-infected people due to AIDS [3].  ART restores immune function and reduces HIV-related adverse outcomes. Despite documented benefits of antiretroviral drugs, its use is not without side effects. Second-generation INSTIs are currently the class of choice in ART regimens due to their high potency, good tolerability, low toxicity and high genetic barrier to resistance. INSTIs are believed to work by chelating magnesium ion to prevent HIV from integrating into host DNA [4].

Thus, estimation of Serum Magnesium levels in people living with HIV on ART is essential to treat hypomagnesaemia and prevent clinical manifestation of Hypomagnesaemia.

AIMS AND OBJECTIVES OF THE STUDY: -

To study serum magnesium levels in PLHIV on antiretroviral therapy.

• STUDY DESIGN: Cross-sectional study
• STUDY DURATION: 18 months

• STUDY AREA: KIMS hospital, Bangalore.
• STUDY PARTICIPANTS: Patients with HIV attending KIMS hospital, Bangalore.
• INCLUSION CRITERIA
  • Patient aged > 18years
  • PLHIV on first line ART
• EXCLUSION CRITERIA
  • Patient under age 18 years.
  • Patients on drugs interacting with serum magnesium levels like lithium, aminoglycoside antibiotics like amikacin, kanamycin. Streptomycin, antineoplastics cisplatin carbaplatin.
  • Patients with renal disease.
  • Patients with endocrine disorders like Addison’s disease and thyroid disease.
  • Patients with liver disorders

SAMPLE SIZE:

The sample size for the present study has been estimated using the software GPower v. 3.1.9.4 (Franz Faul, Universität Kiel, Germany) Considering the effect size to be measured (d) at 80% for Two-tailed Hypotheses based on the study done by Mudzinge D et al [5], power of the study at 80% and the alpha error at 5%, the total sample size needed is 50. Thus, each group will comprise of 25 samples.

METHOD OF COLLECTION OF DATA:

The study was conducted in department of medicine, KIMS hospital, Bangalore. Clearance from the institutional ethical committee was taken before starting the study. Written consent was obtained from all the study participants samples. Study participants were included in the study by Purposive Sampling technique. A pretested, semi-structured questionnaire was used to collect the information on socio-demographic variables and history of HIV by interview method. Serum magnesium levels were evaluated and compared with controls

STATISTICAL ANALYSIS:

The data was collected and compiled in MS Excel. Descriptive statistics has been used to present the data. To analyse the data SPSS (Version 26.0) was used. Significance level was fixed as 5% (α = 0.05). Qualitative variables are expressed as frequency and percentages and Quantitative variables are expressed as Mean and Standard Deviation. To compare the proportion between variables, chi-square test was used. To compare the mean values between variables, student t test was used.

The mean age of the cases and controls were found to be 49.32+7.587 and 49.28+7.531 respectively. 84% of the study participants in each group were males. 4% of the study participants in each group had type 2 diabetes mellitus. The mean duration of ART among the cases was found to be 13.48+4.736 months. The mean serum magnesium among the cases and controls were found to be 1.7188+0.238 and 2.0300+0.232 respectively. The mean serum magnesium levels were found to be lower among the cases than the controls with statistical significance (P<0.05).

TABLE 1: PATIENT CHARACTERISTICS

TABLE 2: SERUM MAGNESIUM

Afridi HI, Kazi TG, Talpur FN, et al. included sixty-two males with HIV (HIV-1) or AIDS and 120 healthy males of the same age group (31-45 years) [6], the results of which indicated significantly lower levels of serum magnesium of patients in comparison to the healthy controls (p < 0.01) which is in consonance with our study.

Obum-Nnadi CN, Nathaniel O, Mbata TI, et al. study 3showed that there was a significant association of the level of magnesium in the plasma in both genders with HIV/AIDS infection [7] which was observed in our study.

Pantaleo G, Graziosi C, Fauci AS et al. study [8] reported that serum magnesium in HIV/AIDS patients was low, and the present study confirmed it.

The results provide additional evidence that lower magnesium concentrations occur in HIV-infected subjects compared to healthy controls. Close monitoring of magnesium is necessary especially when the patients receive drugs that can complicate magnesium deficiency. Further studies are needed to investigate the possible association between magnesium and CD4 cells.

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