Abstract
Human Immunodeficiency virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) are associated with dysfunction of many endocrine organs and their axis. HIV infectivity leads to altered metabolism, poor oral intake and increased prevalence of weight loss and wasting which may have a role in thyroid dysfunction. Overt thyroid dysfunction occurs at similar rates as the general population while subclinical disease such as nonthyroidal illness (sick euthyroid syndrome), subclinical hypothyroidism and isolated low T4 levels are more frequent. Moreover, HAART therapy can complicate thyroid function further through drug interactions and the immune reconstitution inflammatory syndrome (IRIS). In this review we report the common thyroid dysfunctions associated with HIV before and after HAART therapy. We discuss presentation, diagnostic work up, treatment and follow up in each condition.
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References
Boelaert K, Franklyn JA. Thyroid hormone in health and disease. J Endocrinol. 2005;187:1–15.
Franklyn JA. The thyroid- too much and too little across the ages. The consequences of subclinical thyroid dysfunction. Clin Endocrinol. 2013;78(1):1–8.
Grunfeld C, Pang M, Doerrier W, et al. Indices of thyroid function and weight loss in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Metabolism. 1993;42(10):1270–6.
Olivieri A, Sorcini M, Battisti P, et al. Thyroid hypofunction related with the progression of human immunodeficiency virus infection. J Endocrinol Invest. 1993;16:407–13.
Kosmiski L. Energy expenditure in HIV infection. Am J Clin Nutr. 2011;94(6):16775–825.
Mittelsteadt AL, Hileman CO, Harris SR, et al. Effects of HIV and antiretroviral therapy on resting energy expenditure in adult HIV-infected women—a matched, prospective, cross-sectional study. J Acad Nutr Diet. 2013. doi:10.1016/j.jand.2013.02.005.
Mangili A, Murman DH, Zampini AM, Wanke CA, Mayer KH. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort. Clin Infect Dis. 2006;42(6):836–42.
Hirschfeld S, Laue L, Cutler Jr GB, Pizzo PA. Thyroid abnormalities in children infected with human immunodeficiency virus. J Pediatr. 1996;128(1):70–4.
Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489.
Golden SH, Robinson KA, Saldanha I, et al. Prevalence and incidence of endocrine and metabolic disorders in the United Staes: a comprehensive review. J Clin Endocrinol Metab. 2009;94(6):1853–78.
Beltran S, Lescure F-X, Esper IE, et al. Subclinical hypothyroidism in HIV infected patients is not an autoimmune disease. Horm Res. 2006;66:21–6.
Madge S, Smith C, Lampe F, et al. No association between HIV disease and its treatment and thyroid function. HIV Med. 2006;7(supp 1):23. abstract P49.
Noureldeen A, Qusti SY, Khoja GM. Thyroid function in newly diagnosed HIV-infected patients. Toxicol Ind Health. 2012. doi:10.1177/0748233712466133.
Fundaro C, Olivieri A, Rendeli C, et al. Occurrence of anti-thyroid autoantibodies in children vertically infected with HIV-1. J Pediatr Endocrinol Metab. 1998;11(6):745–50.
Chiarelli F, Galli L, Verrotti A, et al. Thyroid function in children with perinatal human immunodeficiency virus type 1 infection. Thyroid. 2000;10(6):499–505.
Rana S, Nunlee-Bland G, Valyasevi R, Iqbal M. Thyroid dysfunction in HIV-infected children: is L-thyroxine therapy beneficial? Pediatr AIDS HIV Infect. 1996;7(6):424–8.
Marino R, Hegde A, Barnes KM, et al. Catch up growth after hypothyroidism is caused by delayed growth plate senescence. Endocrinology. 2008;149(4):1820–8.
Touzot M, Le Beller C, Touzot F, et al. Dramatic interaction between levothyroxine and lopinavir/ritonavir in an HIV infected patient. AIDS. 2006;20:1210–2.
Lanzafame M, Trevenzoli M, Faggian F, et al. Interaction between levothyroxine and indinavir in a patient with HIV infection. Infection. 2002;30(1):54–5.
Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: co-sponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;11:1–207.
Beltran S, Lescure F-X, Desailloud R, et al. Increased prevalence of hypothyroidism among human immunodeficiency virus- infected patients: a need for screening. Clin Infect Dis. 2003;37:579–83.
Merenich J, McDermott T, Asp A, et al. Evidence of endocrine involvement early in the course of human immunodeficiency virus infection. J Clin Endocrinol Metab. 1990;70:566–71.
Quirino T, Bongiovanni M, Ricci E, et al. Hypothyroidism in HIV-infected patients who have or have not received HAART. Clin Infect Dis. 2004;38(4):596–7.
Madeddu G, Spanu A, Chessa F, et al. Thyroid function in human immunodeficiency virus patients treathed with highly active antiretroviral therapy (HAART): a longitudinal study. Clin Endocrinol. 2006;64:375–83.
Calza L, Manfredi R, Chiodo F. Subclinical hypothyroidism in HIV-infected patients receiving highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31:361–2.
Bongiovanni M, Adorni F, Casana M, et al. Subclinical hypothyroidism in HIV-infected patients. J Antimicrob Chemother. 2006;58(5):1086–9.
Grappin M, Piroth L, Verges B, et al. Increased prevalence of subclinical hypothyroidism in HIV patients treated with highly active antiretroviral therapy. AIDS. 2000;14:1070–2.
Hoffman CJ, Brown TT. Thyroid function abnormalities in HIV-infected patients. Clin Infect Dis. 2007;45:488–94.
Sellmeyer DE, Grrunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev. 1996;17:518–27.
Dobs AS, Dempsy MA, Ladenson PW, Polk BF. Endocrine disorders in men infected with the human immunodeficiency virus. Am J Med. 1988;84:611–6.
Collazos J, Ibarra S, Mayo J. Thyroid hormones in HIV infected patients in the highly active antiretroviral therapy era: evidence of an interrelationship between the thyroid axis and the immune system. AIDS. 2004;17:763–5.
Vigano A, Riboni S, Bianchi R, et al. Thyroid dysfunction in antiretroviral treated children. Pediatr Infect Dis J. 2004;23(3):235–9.
Raffi F, Brisseau JM, Planchon et al. Endocrine function in 98 HIV- infected patients: a prospective study. AIDS. 1991;5:729–733
Zavaschi AP, Maia AL, Goldani LA. Pneumocystis jiroveci thyroiditis: report of 15 cases in the literature. Mycoses. 2007;50(6):443–6.
Jinno S, Chang S, Jocobs MR. Coccidioides thyroiditis in an HIV-infected patient. J Clin Microbiol. 2012;50(7):2535–7.
Kiertiburanakul S, Sungkanuparph S, Malathum K, Pracharktam R. Concomitant tuberculous and cryptococcal thyroid abscess in a human immunodeficiency virus infected patient. Scand J Infect Dis. 2003;35(1):68–70.
Trzepacz PT, McCue M, Klein I, et al. Graves’ disease: an analysis of thyroid hormone levels and hyperthyroid signs and symptoms. Am J Med. 1989;87:558–61.
Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593–646.
Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348:2646–55.
Chen F, Day SL, Metcalfe RA, et al. Characteristics of autoimmune thyroid disease occurring as a late complication of immune reconstitution in patients with advanced human immunodeficiency virus (HIV) disease. Medicine. 2005;84(2):98–106.
Douek DC, McFarland RD, Keiser PH, et al. Changes in thymic function with age and during the treatment of HIV infection. Nature. 1998;396:690–5.
Pakker NG, Notermans DW, de Boer RJ, et al. Biphasic kinetics of peripheral blood T cells after triple combination therapy in HIV-1 infection: a composite of redistribution and proliferation. Nat Med. 1998;4(2):208.
Autran B, Carcelain G, Li TS, et al. Positive effects of combined antiretroviral therapy on CD + T cell homeostasis and function in advanced HIV disease. Science. 1997;277(5322):112–6.
Imami N, Antonopoulos C, Hardy GA, et al. Assessment of type 1 and type 2 cytokines in HIC type 1 infected individuals: impact of highly active antiretroviral therapy. AIDS Res Hum Retrovir. 1999;15:1499–508.
Mullur M, Wandel S, Colebunders R, et al. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(4):251–61.
Grant PM, Komarow L, Andersen J, et al. Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early vs. deferred ART during an opportunistic infection. PLoS One. 2010. 5(7). doi:10.1371/journal.pone.0011416
Jubault V, Penfornis A, Schillo F, et al. Sequential occurance of thyroid autoantibodies and Graves disease after immune restoration in severely immunocompromised human immunodeficiency virus-1 infected patients. J Clin Endocrinol Metab. 2000;85:4254–7.
Vos F, Pieters G, Keuter M, van der Ven A. Graves’ disease during immune reconstitution in HIV infected patients treated with HAART. Scand J Infect Dis. 2006;38(2):124–6.
Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249–52.
Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295:1033–41.
Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352:905–917.
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Parsa, A.A., Bhangoo, A. HIV and thyroid dysfunction. Rev Endocr Metab Disord 14, 127–131 (2013). https://doi.org/10.1007/s11154-013-9248-6
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DOI: https://doi.org/10.1007/s11154-013-9248-6