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Abnormal Thyroid Function in Children With HIV
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Written for NATAP: A report from the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Dec 2005.
Mark Mascolini
A study of 34 boys and 34 girls infected around birth with HIV found that 10 of them (15%) had clinically inapparent thyroid abnormalities [1]. Children with thyroid problems had worse immunodeficiency than those without such problems. But antiretroviral therapy, in itself, did not seem to affect thyroid status in this small cohort.
Pediatricians at the University of Milan studied 68 children averaging 10.9 years of age (+ 4.7 years standard deviation). Twelve were not taking antiretrovirals, but all were clinically stable.
Over the course of follow-up (which these researchers did not define), subclinical hypothyroidism emerged in 3 children and free triiodothyronine levels rose above normal in 7. Echograms showed reduced thyroid size in only 1 of these 10 children, and none had symptoms of thyroid disease.
Children with thyroid abnormalities had significantly lower CD4 counts than other children (median 617 versus 840 cells/mm3, P < 0.05) and lower CD4 percents (median 22% versus 32%, P < 0.05). Viral load and HIV disease stage did not differ between children with and without thyroid problems.
Two children (17%) with thyroid dysfunction were not taking antiretrovirals, compared with 8 (14%) who had normal thyroid function, a nonsignificant difference.
None of the children studied needed L-thyroxine replacement therapy.
The authors suggest regular thyroid function monitoring in children with moderate or severe immunosuppression.
Thyroid disease in children with HIV clearly deserves further study because the virus attacks T cells made in the thymus. Children infected at birth may carry HIV for 60 or 70 years, starting and stopping antiretrovirals many times along the way. How their thymus responds to this on-and-off assault over the decades is anyone's guess.
Mark Mascolini writes about HIV infection
Reference
1. Esposito S, Porta A, Bojanin J, et al. Thyroid dysfunction in HIV-infected children: evidence of an interrelations between the thyroid axis and the immune system. 45th Interscience Conference on Antimicrobial Agents and Chemotherapy. December 16-29, 2005. Washington, DC. Abstract H-1105.
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