Thyroid function in human immunodeficiency virus patients treated with highly active antiretroviral therapy (HAART): a longitudinal study
Articolo
Data di Pubblicazione:
2006
Citazione:
Thyroid function in human immunodeficiency virus patients treated with highly
active antiretroviral therapy (HAART): a longitudinal study / Madeddu, Giordano; Spanu, Angela; Chessa, F; Calia, Gm; Lovigu, C; Solinas, P; Mannazzu, M; Falchi, A; Mura, Maria Stella Anna; Madeddu, Giuseppe. - In: CLINICAL ENDOCRINOLOGY. - ISSN 0300-0664. - 64:4(2006), pp. 375-383.
Abstract:
OBJECTIVE: Given that few and controversial data have been reported on thyroid
function in human immunodeficiency virus (HIV) patients on highly active
antiretroviral therapy (HAART), we further investigated whether HAART affects
thyroid hormones.
DESIGN AND PATIENTS: Two hundred two consecutive adult HIV patients in stable
clinical condition were enrolled, 182 on HAART and 20 naïve; 128 were rechecked
during follow-up. Body mass index (BMI), CD4 cell count, HIV RNA, hepatitis C and
B virus status and infection duration were determined in all HIV patients and
HAART duration in treated patients. In all patients and in 60 controls, the
following were measured: FT4 and FT3 by radioimmunoassay; TSH, antithyroid
peroxidase (TPO) and antithyroglobulin (TG) antibodies by immunoradiometric
assay.
RESULTS: Abnormalities in thyroid function tests were found in 23/182 (12.6%)
HAART patients, but not in naïve patients. Most abnormalities were subclinical
hypothyroidism, with mean FT4 and TSH levels lower and higher, respectively, in
HAART patients compared to naïve patients and controls, FT4 levels being
significantly lower than controls. TSH negatively correlated with CD4 count nadir
and positively with HAART duration. During follow-up, FT4 and FT3 significantly
decreased and TSH increased in patients continuing HAART, whereas CD4 counts were
unmodified; subclinical hypothyroid conditions persisted and further cases
occurred, whereas the only hypothyroid patient who interrupted HAART shows a
normalization of thyroid tests. Patients on stavudine, included in most
hypothyroid patient protocols, had significantly lower FT4 levels with prolonged
treatment.
CONCLUSIONS: HAART, particularly stavudine, is associated with a high prevalence
of subclinical hypothyroidism. Hypotheses are made regarding responsible
mechanisms and risk factors. Thyroid function should be tested and sequentially
rechecked in HAART patients.
function in human immunodeficiency virus (HIV) patients on highly active
antiretroviral therapy (HAART), we further investigated whether HAART affects
thyroid hormones.
DESIGN AND PATIENTS: Two hundred two consecutive adult HIV patients in stable
clinical condition were enrolled, 182 on HAART and 20 naïve; 128 were rechecked
during follow-up. Body mass index (BMI), CD4 cell count, HIV RNA, hepatitis C and
B virus status and infection duration were determined in all HIV patients and
HAART duration in treated patients. In all patients and in 60 controls, the
following were measured: FT4 and FT3 by radioimmunoassay; TSH, antithyroid
peroxidase (TPO) and antithyroglobulin (TG) antibodies by immunoradiometric
assay.
RESULTS: Abnormalities in thyroid function tests were found in 23/182 (12.6%)
HAART patients, but not in naïve patients. Most abnormalities were subclinical
hypothyroidism, with mean FT4 and TSH levels lower and higher, respectively, in
HAART patients compared to naïve patients and controls, FT4 levels being
significantly lower than controls. TSH negatively correlated with CD4 count nadir
and positively with HAART duration. During follow-up, FT4 and FT3 significantly
decreased and TSH increased in patients continuing HAART, whereas CD4 counts were
unmodified; subclinical hypothyroid conditions persisted and further cases
occurred, whereas the only hypothyroid patient who interrupted HAART shows a
normalization of thyroid tests. Patients on stavudine, included in most
hypothyroid patient protocols, had significantly lower FT4 levels with prolonged
treatment.
CONCLUSIONS: HAART, particularly stavudine, is associated with a high prevalence
of subclinical hypothyroidism. Hypotheses are made regarding responsible
mechanisms and risk factors. Thyroid function should be tested and sequentially
rechecked in HAART patients.
Tipologia CRIS:
1.1 Articolo in rivista
Elenco autori:
Madeddu, Giordano; Spanu, Angela; Chessa, F; Calia, Gm; Lovigu, C; Solinas, P; Mannazzu, M; Falchi, A; Mura, Maria Stella Anna; Madeddu, Giuseppe
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