Thyroid dysfunction in patients on antiretroviral therapy: A perspective from southern India

Sebastian, Savitha Anne; Sumithra, S; Kurian, Jithu; Mathew, Vivek; Idiculla, Jyothi

doi:10.4103/0970-258x.255753

Cited by 3 publications

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“…Other studies reported a significative higher prevalence of TDs in PLWH, ranging from 16% to 33.1% 11,26–29 , since they included also subclinical TDs in their analysis. If we compare the sole prevalence of overt hypo and hyperthyroidism in HIV-positive individuals, our data are similar to those found by other Authors, although their studies were performed in much smaller cohorts 17,30–32 . Moreover, in our cohort all patients were on stable cART at TD diagnosis, confirming that well treated PLWH are not at an increased risk of thyroid dysfunction, as previous described 14–17 .…”

Section: Discussionsupporting

confidence: 88%

Low prevalence of symptomatic thyroid diseases and thyroid cancers in HIV-infected patients

Properzi

Giustina

Mentasti

et al. 2019

Sci Rep

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thyroid diseases (tDs) have been widely associated with HiV infection. However, data about tDs prevalence and distribution are controversial, and few published studies are available. the aim of our study was to assess prevalence and risk factors of symptomatic thyroid disturbances, including thyroid cancers, in a large cohort of HiV-infected patients. A retrospective cohort study was performed at the Department of infectious and tropical Diseases of the University of Brescia, italy, in the period 2005-2017. We identified all HIV-positive patients with a diagnosis of symptomatic TD in the electronic database of our Department (HiVeDB); we also operated a record-linkage between our data and the Health protection Agency database (HpADB) of Brescia province. Multivariate logistic regression analysis was used to determine risk factors associated with tDs onset; an incidence rate analysis was also performed. During the study period, 6343 HIV-infected patients have been followed at our Department; 123 received a diagnosis of symptomatic TD (1.94% of the entire cohort). In the TDs group, almost half of patients were females (n = 59, 48%), mean age was 47.15 years (SD: 11.56). At TD diagnosis, mean T CD4+ cell count was 491 cell/uL and most patients showed undetectable HIV-RNA (n = 117, 95.12%). Among them, 81 patients were found to have hypothyroidism (63 with Hashimoto's thyroiditis), 21 hyperthyroidism (17 suffered from Graves' disease), while 11 subjects were diagnosed with a primitive thyroid cancer. papillary thyroid cancer was the most frequent histotype (n = 7, 63.63%), followed by medullary (n = 2, 18.18%) and follicular thyroid cancer (n = 1, 9.1%). Male gender was a protective factor for tDs development, especially for hypothyroidism (p < 0.001); age emerged as a variable associated with both hypothyroidism (p = 0.03) and thyroid cancer (p = 0.03), while CD4+ cell nadir <200 cell/ mm 3 was associated with symptomatic hyperthyroidism (p = 0.005). To conclude, symptomatic thyroid dysfunctions rate in well-treated HiV-infected patients is low. Age and gender are crucial elements in the onset of thyroid abnormalities, together with T CD4+ cell nadir. interestingly, medullary thyroid cancer seems to be much more frequent in HiV-infected patients compared to the general population. Various alterations in endocrine homeostasis were described in HIV-infected patients 1-3. In particular, thyroid diseases (TDs) have been widely associated with HIV infection since the start of the epidemic, long before the beginning of the combination antiretroviral therapy (cART) era 4-6. However, there are controversial data concerning thyroid dysfunctions in people living with HIV (PLWH), as previous studies reported both a higher than expected prevalence of TDs 7-13 and no apparent increased prevalence of TDs in this population 14-17. In well-treated HIV-positive individuals, subclinical hypothyroidism 7,9,11-13,18 and isolated low free thyroxine (FT4) levels 6,10,19 are the most common described alterations. Anyway, although it is es...

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Section: Discussionsupporting

confidence: 88%

Low prevalence of symptomatic thyroid diseases and thyroid cancers in HIV-infected patients

Properzi

Giustina

Mentasti

et al. 2019

Sci Rep

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Study of thyroid dysfunction in people living with HIV in Nepalese population undergoing antiretroviral therapy: a cross-sectional study

Sah

Ansari²,

Sah³

et al. 2023

Int J STD AIDS

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Introduction Thyroid dysfunction is one of the most common endocrine disorders in people living with HIV (PLHIV). The abnormality in thyroid function has been linked with the adverse effects of prolonged antiretroviral therapy (ART) in PLHIV, but its prevalence remains obscure. The present study aimed to determine the prevalence of impaired thyroid function and its relationship to ART duration in Nepalese people living with HIV. Methods This cross-sectional clinical laboratory based study was conducted at SRL Diagnostics Nepal, Pvt. Ltd. from October 2021 to May 2022. Two hundred and three HIV-seropositive patients enrolled at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal were examined for their thyroid function test (TFT) by analyzing the serum T3, T4, and TSH concentrations using a fully automated COBAS e411 analyzer (Roche Diagnostics, USA) based on the electrochemiluminescence assay (ECLIA). Results Out of 203 PLHIV, 22 (10.83%) had a thyroid disorder, with subclinical hypothyroidism ( n = 16, 72.73%) being the most common, followed by subclinical hyperthyroidism ( n = 3, 13.63%). Thyroid dysfunction had no significant correlation with HIV/ART duration ( p = 0.304) and sex ( p = 0.419), whereas, the risk of thyroid dysfunction was induced with the rise in the age of the PLHIV ( p = 0.002, ϕ = 0.274). There were no significant differences in the mean serum T3, T4 and TSH values among different sexes and the HIV/ART duration, however a significant difference in the mean values of TSH (F (3, 199) = 3.231, p = 0.023) and T3 (F (3, 199) = 4.587, p = 0.004) among the different age-groups were shown. The mean T3 values also indicated a gradual decrease with increasing age. Conclusion The study revealed subclinical hypothyroidism as the prevailing thyroid disorder associated with PLHIV. The risk of thyroid dysfunction in PLHIV was neither gender specific nor being attributed by the ART duration in Nepalese population; however, elderly PLHIV were highly susceptible to the risk of thyroid disorder.

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The Association of CD4, CD8, and CD4/CD8 Ratio with Thyroid Dysfunction in HIV/AIDS

Mulyani

Pramudianti

Ariningrum

2021

Indonesian J. Clin. Pathol. Med. Lab.

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Incidence of thyroid dysfunction increases in HIV/AIDS patients. It can be a hypothyroid or hyperthyroid, with subclinical hypothyroid predomination. Thyroid dysfunction is associated with the progression of HIV and low CD4 counts. There has been controversy over how HIV affects thyroid function. Opportunistic infections and HBV/HCV co-infections might increase the probability of thyroid dysfunction. Medication of HIV is also an important factor of thyroid dysfunction. Research shows that the use of ART increases the probability of thyroid dysfunction. This study aimed to analyze the association between CD4 counts, CD8, CD4/CD8 ratio, and HIV RNA viral load with thyroid dysfunction in HIV/AIDS patients. An observational study with a cross-sectional design was conducted from August to September 2020 in Dr. Moewardi Hospital, Surakarta on 60 HIV/AIDS patients. All subjects were 18-60 years old. The research data were analyzed with a 2x2 test table to determine the Prevalence Ratio (PR) of each variable, then multivariate analysis with logistic regression was continued. The study showed 6.7% thyroid dysfunction in HIV/AIDS patients, 5% subclinical hyperthyroidism, and 1.7% subclinical hypothyroidism. The CD4 counts [PR 13.36 (95% CI: 1.53-116,65; p=0.017) and CD8 counts [PR 0.91 (95% CI: 3 0.02-0.51; p=0.032)] significantly associated with thyroid dysfunction in HIV/AIDS patients. CD4 counts < 200 cells/mm and 3 CD8 counts ≥500 cells/mm were associated with the incidence of thyroid dysfunction in HIV/AIDS patients, while CD4/CD8 ratio and HIV RNA viral load were not associated. CD4 count was not an independent predictor of thyroid dysfunction in HIV/AIDS patients.

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Thyroid dysfunction in patients on antiretroviral therapy: A perspective from southern India

Cited by 3 publications

References 0 publications

Low prevalence of symptomatic thyroid diseases and thyroid cancers in HIV-infected patients

Low prevalence of symptomatic thyroid diseases and thyroid cancers in HIV-infected patients

Study of thyroid dysfunction in people living with HIV in Nepalese population undergoing antiretroviral therapy: a cross-sectional study

The Association of CD4, CD8, and CD4/CD8 Ratio with Thyroid Dysfunction in HIV/AIDS

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