Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy

Rasul, Samad; Delapenha, Robert; Farhat, Faria; Gajjala, Jhansi; Zahra, Syeda Mehreen

doi:10.1155/2011/743597

Cited by 25 publications

(31 citation statements)

References 13 publications

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“…10 In a more recent report, two patients developed G-IRD after being on cART for 12 and 28 months. 11 Similar to previous cases, 2,5,12 in our series most of the patients with G-IRD had advanced immunosuppression (low CD4 + T-cell count) before the initiation of cART, and experienced rapid recovery of CD4 + T-cell counts and virologic suppression well before the detection of G-IRD.…”

supporting

confidence: 86%

“…4 In Graves' disease, the majority of cases are idiopathic, but immune restoration after cART has been identified as a cause, now called Graves' immune restoration disease (G-IRD). 5 The pathogenesis is thought to be similar to that of Graves' disease, with autoantibodies binding to and activating the TSH receptor. Clinical and laboratory diagnostic criteria for G-IRD are unchanged compared with Graves' disease.…”

mentioning

confidence: 99%

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Short Communication: Hyperthyroidism in Human Immunodeficiency Virus Patients on Combined Antiretroviral Therapy: Case Series and Literature Review

Hsu

Phadke

Nguyen

2016

AIDS Research and Human Retroviruses

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We describe an HIV-infected patient initiated on combined antiretroviral therapy (cART) who subsequently developed immune restoration disease (IRD) hyperthyroidism-this case represents one of five such patients seen at our center within the past year. Similar to previous reports of hyperthyroidism due to IRD, all of our patients experienced a rapid early recovery in total CD4 count, but developed symptoms of hyperthyroidism on average 3 years (38 months) after beginning cART, which represents a longer time frame than previously reported. Awareness and recognition of this potential complication of cART, which may occur years after treatment initiation, will allow patients with immune restorative hyperthyroidism to receive timely therapy and avoid the long-term complications associated with undiagnosed thyroid disease.

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supporting

confidence: 86%

mentioning

confidence: 99%

Short Communication: Hyperthyroidism in Human Immunodeficiency Virus Patients on Combined Antiretroviral Therapy: Case Series and Literature Review

Hsu

Phadke

Nguyen

2016

AIDS Research and Human Retroviruses

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“…Furthermore, it was recently suggested that Graves' disease development represents an immune reconstitution inflammatory syndrome (IRIS) induced by HAART (25). Evaluation of the studies cited above suggested that the association between thyroid dysfunction progression, or development of autoimmunity, in HAART patients remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of thyroid function and autoimmunity in HIV-infected women

Carvalho

Teixeira

Panico

et al. 2013

Arq Bras Endocrinol Metab

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Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active antiretroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4 + lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIVinfected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4 + T cell counts. Arq Bras Endocrinol Metab. 2013;57(6):450-6Keywords Autoimmune thyroid disease; thyroid dysfunction; hypothyroidism; hyperthyroidism; HIV; anti-retroviral therapy; immunity RESUMO Doenças tiroidianas autoimunes (DTAI) são a maior causa de disfunção tiroidiana e são as doenças autoimunes mais comuns no mundo. A associação entre DTAI e infecções com o vírus da imunodeficiência humana (HIV), em combinação com a terapia antirretroviral altamente ativa (HAART), foi sugerida por vários grupos de pesquisadores. O objetivo do presente estudo foi avaliar a frequência de disfunção tiroidiana e DTAI em mulheres com mais 35 anos de idade infectadas com o HIV e identificar fatores associados com a emergência dessas anormalidades tiroidianas. As mulheres infectadas com HIV (n = 153), selecionadas do ambulatório de doenças infecciosas de um hospital universitário do Rio de Janeiro, foram caracterizadas com base no nível de linfócitos CD4 + circulantes, carga viral, níveis de TSH sérico e presença de anticorpos FT4 e antitiroperoxidase (TPO-Ab). Um total de 129 participantes se tratava com HAART e 24 não. A frequência de desordens da tiroide foi 7,8% (12/153 pacientes) e todas estavam em tratamento com HAART no momento do diagnóstico, levando a uma prevalência 9,3% em pacientes recebendo HAART, em comparação com 0% em pacientes não tratadas com HAART. DTAI, hipertireoidismo e hipotireoidismo foram detectados em 4,6%, 3,1% e 4,1% das pacientes tratadas com HAART. Não foram detectadas disfunção tiroidiana ...

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“…These changes are evoking the autoimmune phenomena described in the immune reconstitution syndrome, for example observed in human immunodeficiency virus infection (41,42,43,44). These immune changes may explain the occurrence of post partum thyroiditis, basically, an attenuated form of Hashimoto's thyroiditis, which is much more common than the occurrence of Graves' disease in the post partum period (45,46).…”

Section: Hormonesmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Role of emotional stress in the pathophysiology of Graves' disease

Falgarone¹,

Heshmati²,

Cohen³

et al. 2013

European Journal of Endocrinology

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The role of stress in the pathophysiology of Graves' disease is suggested by several clinical observations, by recent advances in immunology and by better understanding of autoimmune diseases which provides new insights into potential effects of stress hormones on T helper cell imbalance involved in the pathogenesis of autoimmune diseases. Stress management should therefore be an important part of the treatment of Graves' disease, as stress reduction may improve the effect of therapy. However, this field still requires interventional data to support stress management in the treatment of Graves' disease. European Journal of Endocrinology 168 R13-R18

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Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy

Cited by 25 publications

References 13 publications

Short Communication: Hyperthyroidism in Human Immunodeficiency Virus Patients on Combined Antiretroviral Therapy: Case Series and Literature Review

Short Communication: Hyperthyroidism in Human Immunodeficiency Virus Patients on Combined Antiretroviral Therapy: Case Series and Literature Review

Evaluation of thyroid function and autoimmunity in HIV-infected women

MECHANISMS IN ENDOCRINOLOGY: Role of emotional stress in the pathophysiology of Graves' disease

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