[16] High prevalence of thyroid abnormalities in the era of highly active antiretroviral therapy

3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

23-26 October 2001, Athens, Greece

High prevalence of thyroid abnormalities in the era of highly active antiretroviral therapy

Antiviral Therapy 2001; 6(Suppl. 4):12 (abstract no. 16)

JL Esnault¹, E Billaud¹, B Milpied¹, B Bonnet¹, A Murat², S Leautez¹ and F Raffi¹
¹Infectious Diseases, CHU Nantes, France; and ²Endocrinology, CHU Nantes,France

BACKGROUND: Recent reports have outlined a high frequency of thyroid disorders in HIV patients treated with highly active antiretroviral therapy (HAART). To better determine the prevalence of thyroid abnormalities in this population, we conducted a prospective study.

METHODS: Two hundred and twenty-one HIV-infected patients (163 men, 58 women, mean age: 40.5 years) were consecutively enrolled in a cross-sectional study. Thyroxin stimulating hormone (TSH) and free T4 (FT4) were tested. Patients were examined and questioned about clinical manifestations. Charts were reviewed for antiretroviral therapy and clinical history.

RESULTS: Twenty-nine patients (13.1%) had biological thyroid abnormalities (CDC classification A 29.6%, B 22.2%, C 48.2%), two patients had hyperthyroidism (graves diseases). Free T4 below normal value was present in 13 patients. 19 patients had TSH >4 UI/ml (normal value: 0.20-4 UI/ml). Four patients had both abnormalities. After control one month later, the diagnosis of hypothyroidism was confirmed in 18 patients (7.6%), 13 men and 5 women. Five patients (2.3%) had significant clinical symptoms needing opotherapy. Asthenia was declared by 27.6% in the studied HIV population and in 29.8% of patients with thyroid abnormalities. 29.4% patients had a clinical lipodystrophy (physician appreciation). Univariate analysis showed that time on protease inhibitor (PI) therapy was correlated with FT4 (r=-0.22, P<10^-3), and TSH (r=0.15, P=0.02). TSH was correlated with triglycerides (r=0.18, P=0.01) and CD4 cell count (r=-0.16, P=0.02)

CONCLUSIONS: According to the Framingham study, prevalence of hypothyroidism in the general population is 0.1% in men and 1% in women. In our study, prevalence of hypothyroidism was 7.9% in men and 8.6% in women, and more frequent in AIDS patients. There is a correlation between duration of PI use and level of FT4 addressing the issue of PIs retinoid like effect on thyroid function but also the role of HIV infection by itself.

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