Thyroid Dysfunction in patients with HIV infection

Nikolaos Kalogeris; Eleni Herolidi; Melpomeni Moustaki; Alexandros Dermetzoglou; Vasilikh Loi; Eleni Vakali; Athina Lioni; Vissaria Sakka; Nikolaos Mangafas; Maria Chini; Andromahi Vryonidou

doi:10.1530/endoabs.70.EP470

Background: The incidence of endocrine complications among patients with HIV infection has decreased over the last years owing to widespread administration of combined Antiretroviral Therapy (cART) at early stages of the disease. We conducted a prospective observational study aiming to characterize the effects of cART on thyroid function in a cohort of newly diagnosed treatment-naive male patients.

Materials and methods: Male subjects diagnosed with HIV infection at the Infectious Diseases Unit during the period from 2015 until 2017 participated in the study after informed consent. Thyroid hormones, free thyroxine (fT4) and triiodothyronine (T3), thyroid stimulating hormone (TSH) and anti-thyroid antibody levels were measured at baseline, 12 and 24 months post-CART initiation. CD4 lymphocytes were assessed, as appropriate. SPSS 22.0 was used for the statistical analysis of the results.

Results: Fifty-five men attended their first and second year follow-up visits. All subjects had Caucasian ethnic background; the average age was 36.3 ± 10.3 years, and median duration of HIV infection was 20.5 months (2–132). Two subjects (3.6%) had co-infection with hepatitis B, while 5 subjects (9.1%) had a positive family history for autoimmune thyroid disease. From 30 patients in whom anti-thyroid antibodies were measured, only 4 had positive values (13.3%). Two years after cART initiation, CD4 number increased significantly (578 ± 315 vs 840 ± 332, P < 0.001) and fT4 level decreased (1.00 ± 0.11 vs 0.96 ± 0.12, P = 0.028), while no change in TSH levels was demonstrated (2.14 ± 1.33 vs 2.42 ± 1.75, P = 0.145). The incidence of subclinical hypothyroidism at two-year follow up increased 2.5-fold compared to baseline (4 vs 2 subjects). None of the subjects with subclinical hypothyroidism at baseline progressed to clinical hypothyroidism. Interestingly, subjects with subclinical hypothyroidism had negative anti-thyroid antibodies and no family history for thyroid or other autoimmune disease. Finally, 2 subjects developed clinical hyperthyroidism with positive anti-TSH receptor antibodies (TRAB) at 2 years, one of them presenting a relapse of Graves’ Disease.

Conclusions: In patients with HIV infection, an isolated decrease in fT4 levels is observed after cART initiation; yet, no fT4 value falls below the normal range. Subclinical hypothyroidism is the most frequent thyroid disorder while Gravesʼ Disease is the most clinically important, usually as a result of Immune Reconstitution Inflammatory Syndrome (IRIS).

Endocrine Abstracts

EP470