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"Thyroid Dysfunction in Individuals with HIV Infection: the effect of HAART"
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Sen P, Scourfield A, Smythe J, Stefanovich M, Jones R, Mandalia S, Sullivan, AK, Nelson, MR, Gazzard BG
Chelsea and Westminster Hospital, London, UK
The aim of the study was to evaluate the presence of thyroid disease in HIV-infected individuals and to assess the possible role of HAART in thyroid dysfunction. Individuals with thyroid disease before HIV diagnosis were not included in the analysis. The study reported finding an increase in incidence of thyroid dysfunction in clinic patients studied at their hospital from 0.9 cases per 10,000 person-years pre-HAART to 10.7 cases per 10,000 person-years post-HAART for hypothyroidism, and for hyperthyroidism from 0.4 to 3.4 cases per 10,000-years pre-HAATT and post-HAART, respectively. Among those patients with hyperthyroidism more were taking protease inhibitors, and among those patients with hypothyroidism more were taking NNRTIs, see tables below. The study authors recommended routine thyroid testing for individuals taking HAART.
They reviewed the case notes of all patients prescribed thyroid medication between April 1995 and June 2004. Subsequently prospective screening of thyroid function was performed between August and November 2004 for all patients attending for routine blood tests.
33 patients were prescribed thyroid medication during the study period, an additional 3 had thyroid disease pre-HAART. 25 had hypothyroidism & 8 had hyperthyroidism. 73% were male, 84% white and the mean age was 43 years. The median CD4 count was 228 cells (IQR: 156-325). 87% were white and 6% were Black. Most HIV+ individuals with thyroid dysfunction were receiving medication for this condition.
Of 2437 patients screened, 54 had abnormal thyroid function. 22 had hypothyroidism (52%) and 26 hyperthyroidism (48%), giving clinic prevalence of 1.2% and 1.01%, respectively.
The study authors concluded that these results indicate a significant prevalence of thyroid disease in HIV+ patients on HAART. Hyperthyroidism was more prevalent for PI regimens (p=0.025), and hypothyroidism was more prevalent on NNRTI regimens (p=0.002). Thyroid antibody production in some patients suggests an association with immune restoration following HAART, although thyroid dysfunction was not associated with compromised immune system or low CD4 count. Hyperthyroidism was associated with use of protease inhibitors.
Comments: It would be important to consider risk factors associated with thyroid dysfunction in HIV-negative individuals, including hepatitis viral infection, or interferon therapy for HCV. In the earlier days protease inhibitors were blamed for lipodystrophy and bone loss. So,l it is a good thing to research new complications including thyroid, hepatitis, bone loss, renal impairment, but lets be careful about our interpretation and analysis.
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