Delayed occurrence of Graves' disease after immune restoration with HAART

Gilquin, Jacques; Viard, Jean‐Paul; Jubault, V.; Sert, Caroline; Kazatchkine, Michel D.

doi:10.1016/s0140-6736(05)60398-4

Cited by 80 publications

(43 citation statements)

References 5 publications

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“…We recently reported on the delayed occurrence of Graves' disease (GD) in three deeply immunocompromised patients after recovery of high CD4 ϩ cell counts on HAART (6). Hereafter, we extended this finding and analyzed the relationship between immune restoration on HAART and the kinetics of thyroid autoantibodies and GD in five such patients.…”

mentioning

confidence: 86%

Sequential Occurrence of Thyroid Autoantibodies and Graves’ Disease after Immune Restoration in Severely Immunocompromised Human Immunodeficiency Virus-1-Infected Patients

Jubault

Penfornis²,

Schillo³

et al. 2000

The Journal of Clinical Endocrinology & Metabolism

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We analyzed the kinetics of CD4 cells, human immunodeficiency virus (HIV) viral load, and autoantibodies in acquired immune deficiency syndrome patients with Graves' disease (GD) after immune restoration on highly active antiretroviral therapy (HAART; retrospective study).Five patients (median age, 41 yr) were diagnosed with GD after 20 (range, 14 -22) months on HAART on the basis of clinical and biological hyperthyroidism, diffuse hyperfixation of thyroid scan, and the presence of anti-TSH receptor (anti-TSHR) antibodies (Ab). GD was diagnosed several months after the plasma HIV ribonucleic acid load became undetectable, when the CD4 ϩ cell count had risen from 14 (range, 0 -62) to 340 (range, 163-460) ϫ 10 6 cells/L. Antithyroid peroxidase (anti-TPO) and anti-TSHRAb appeared 14 (range, 9 -18) and 14 (range, 11-20) months after starting HAART and 12 (range, 6 -15) and 11 (range, 9 -17) months after the increase in CD4 ϩ cells. In 3 patients, TPOAb preceded TSHRAb by 3-10 months. No other autoantibodies were detected. Thyroid antibodies were absent in a group of 55 HIV-1-positive patients with comparable response to HAART and no symptoms of hyperthyroidism (cross-sectional study).Thyroid-specific autoimmunity can occur upon immune restoration with HAART. Our observations suggest a relationship between thymus-dependent immune reconstitution after immunosuppression and autoimmunity and may provide insight into the pathophysiology of GD. (J Clin Endocrinol Metab 85: 4254 -4257, 2000)

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confidence: 86%

Sequential Occurrence of Thyroid Autoantibodies and Graves’ Disease after Immune Restoration in Severely Immunocompromised Human Immunodeficiency Virus-1-Infected Patients

Jubault

Penfornis²,

Schillo³

et al. 2000

The Journal of Clinical Endocrinology & Metabolism

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“…Highly active antiretroviral therapy (HAART) has been found to be associated with Graves' disease, occurring 16 -19 months after initiation of different combinations of indinavir, stavudine, lamivudine and ritonavir (117). It may be related to HAART-induced changes in CD4 T cells (118).…”

Section: Antiretroviral Therapymentioning

confidence: 99%

The environment and autoimmune thyroid diseases

2004

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Genetic factors play an important role in the pathogenesis of autoimmune thyroid disease (AITD) and it has been calculated that 80% of the susceptibility to develop Graves' disease is attributable to genes. The concordance rate for AITD among monozygotic twins is, however, well below 1 and environmental factors thus must play an important role. We have attempted to carry out a comprehensive review of all the environmental and hormonal risk factors thought to bring about AITD in genetically predisposed individuals. Low birth weight, iodine excess and deficiency, selenium deficiency, parity, oral contraceptive use, reproductive span, fetal microchimerism, stress, seasonal variation, allergy, smoking, radiation damage to the thyroid gland, viral and bacterial infections all play a role in the development of autoimmune thyroid disorders. The use of certain drugs (lithium, interferon-a, Campath-1H) also increases the risk of the development of autoimmunity against the thyroid gland. Further research is warranted into the importance of fetal microchimerism and of viral infections capable of mounting an endogenous interferon-a response.European Journal of Endocrinology 150 605-618

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“…All patients were treated with antithyroid drugs, some of them required I131 treatment lately and only a few were thyroidectomized [5,[9][10][11][16][17][18][19][20][21]. In our case, radioablation therapy was not an option because of the exophthalmos presence and we decided to begin methimazole in spite of the aplastic anemia low risk.…”

Section: Discussionmentioning

confidence: 99%

“…In 1998, Gilquin et al reported the occurrence of autoimmune hyperthyroidism in 3 patients with HIV after 16 -22 months of beginning HAART [9]. Two years later, Jubault and Gilquin analyzed the relationship between thyroid autoantibodies, GD and immune restoration on HAART in five patients (median age, 41 yr).…”

Section: Discussionmentioning

confidence: 99%

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

Mingote¹,

Urrutia²,

Viteri³

et al. 2013

WJA

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Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves' disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves' disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/µL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/µL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves' disease, which was diagnosed when CD4 T-cells increased up to 343 cell/µL. Our patient developed Graves' disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/µL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.

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Delayed occurrence of Graves' disease after immune restoration with HAART

Cited by 80 publications

References 5 publications

Sequential Occurrence of Thyroid Autoantibodies and Graves’ Disease after Immune Restoration in Severely Immunocompromised Human Immunodeficiency Virus-1-Infected Patients

Sequential Occurrence of Thyroid Autoantibodies and Graves’ Disease after Immune Restoration in Severely Immunocompromised Human Immunodeficiency Virus-1-Infected Patients

The environment and autoimmune thyroid diseases

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

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