Thyroid function in human immunodeficiency virus patients treated with highly active antiretroviral therapy (HAART): a longitudinal study

Abstract

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.

Association between antiretrovirals and thyroid diseases: a cross-sectional study

“…In one prospective study, abnormalities in thyroid function were found in 12.6%. Patients on stavudine had significantly lower FT4 levels with prolonged treatment (25). In other study, the prevalence of subclinical hypothyroidism was 12.2% and the previous use of PI, especially stavudine, had a statistically significant risk association for hypothyroidism when compared to naïve patients (p < 0.05) (29).…”

“…Another manifestation consistent with central dysfunction is the presence of isolated low levels of TSH with normal free T 4 (FT 4 ). This condition was found in 1.3 to 6.8% of HIV-infected individuals, especially those in advanced disease stages (20,(25)(26)(27)(28). However, administration of exogenous TSH releasing hormone (TRH) did not alter the response of TSH among individuals with low FT 4 , making hypothalamic or pituitary insufficiency the least likely scenario (29).…”

“…Although the mechanism is not clear, stavudine has been suggested as a direct intervening agent in the production and/ or metabolism of thyroid hormones, suggesting the need for monitoring thyroid function in HIV patients who have been treated with this medicine (25,28,29). Drug interactions between protease inhibitors and levothyroxine have also been reported through a shared glucuronidation metabolic pathway.…”

A study of thyroid dysfunction in HIV infected patients in a tertiary care hospital

“…Although the prevalence of overt thyroid disease does not appear to be significantly increased as compared to the general population, subtle thyroid dysfunction is common, believed to occur in as many as 35% of all HIV infected individuals. [1][2][3][4] In patients with advanced HIV disease, a variety of systemic opportunistic conditions that infect or infiltrate the thyroid can decrease or increase T 4 secretion.…”

“…[1][2][3] In fact, thyroid dysfunction is among the commonest endocrinopathies in HIV. Although the prevalence of overt thyroid disease does not appear to be significantly increased as compared to the general population, subtle thyroid dysfunction is common, believed to occur in as many as 35% of all HIV infected individuals.…”